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Intussusception following the Ladd procedure
J Kidd1, R Jackson, C W Wagner
1Department of Pediatric Surgery, Arkansas Children's Hospital, Little Rock 72202, USA.
Insights
The Ladd procedure increases the risk of postoperative intussusception (POI) in children. Early reexploration is crucial for children experiencing prolonged ileus after this surgery.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
Background:
- The Ladd procedure is a common surgical intervention for intestinal malrotation.
- Postoperative intussusception (POI) is a known complication following abdominal surgeries in children.
Purpose of the Study:
- To investigate the incidence and predisposing factors of POI after the Ladd procedure.
- To compare the risk of POI after the Ladd procedure versus other laparotomies.
Main Methods:
- Retrospective case-control study at a tertiary care pediatric hospital.
- Reviewed 159 patients undergoing the Ladd procedure and compared POI cases with age-matched controls.
- Compared POI incidence in the Ladd group with 1717 patients undergoing other laparotomies.
Main Results:
- The incidence of POI was 3.1% in the Ladd procedure group, significantly higher than 0.05% in other laparotomies (P<.001).
- Symptoms of POI appeared at a mean of 7.2 days post-surgery, with 4 out of 5 cases showing partial small bowel obstruction.
- Children developing POI were less likely to be small for their age (P=.03).
Conclusions:
- The Ladd procedure is associated with a higher risk of POI in pediatric patients.
- Prompt investigation and reexploration are recommended for children with prolonged ileus within two weeks post-Ladd procedure.
Hypothesis:
The Ladd procedure for malrotation predisposes children to postoperative intussusception (POI).
Design:
Retrospective case-control review.
Setting:
University-affiliated tertiary care pediatric hospital.
Patients:
Five of 159 patients undergoing the Ladd procedure between 1995 and 1998 developed POI. Predisposing factors were sought by comparison with age-matched controls who underwent the Ladd procedure during the same period. The entire Ladd group was compared with all 1717 patients undergoing any other laparotomy during the same period for incidence of POI.
Main Outcome Measures:
Differences in weight, percentile weight, age, length of nasogastric suction, time to oral intake, and length of stay between Ladd patients developing POI and age-matched controls from the Ladd group were compared using the Mann-Whitney U test. Incidence of POI after the Ladd procedure and "other laparotomy" was compared using chi2 analysis.
Results:
In the Ladd group, there were 5 cases of POI (3.1%). There was 1 case of POI (0.05%) after all other laparotomies (P<.001). Symptoms developed at a mean +/- SD of 7.2 +/- 2.1 days. Upper gastrointestinal tract with small bowel follow-through showed partial bowel obstruction in 4 cases and was normal in 1 case. Reexploration took place at a mean +/- SD of 9.2 +/- 2.8 days. Children developing POI after undergoing the Ladd procedure were less likely to be small for their age (P= .03) than age-matched controls undergoing the Ladd procedure.
Conclusions:
The Ladd procedure predisposes children to POI. Aggressive investigation, including reexploration, should not be delayed if a child has symptoms of prolonged ileus within 2 weeks after undergoing a Ladd procedure.