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Surgical treatment of malrotation after infancy: a population-based study
Marcus M Malek1, Randall S Burd
1Department of Surgery, Division of Pediatric Surgery, Robert Wood Johnson Medical School, PO Box 19, New Brunswick, NJ 08903, USA.
Insights
Treatment for malrotation in older children is supported by this study. A Ladd's procedure is recommended for incidentally found malrotation to prevent severe complications.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Clinical Outcomes Research
Background:
- Malrotation typically presents in infancy, with limited data for older children.
- Existing treatment recommendations for older children are based on small case series.
- A large national database was utilized to address this knowledge gap.
Purpose of the Study:
- To determine the clinical significance of malrotation in children over one year of age.
- To establish evidence-based treatment recommendations for this demographic.
- To analyze outcomes of the Ladd's procedure in older children with malrotation.
Main Methods:
- Analysis of the Kids' Inpatient Database (2000) for pediatric discharges.
- Identification of children (>1 year) who underwent a Ladd's procedure.
- Evaluation of patient demographics, diagnoses, procedures, and mortality using discharge weighting for national estimates.
Main Results:
- 362 older children (estimated) underwent a Ladd's procedure for malrotation-related symptoms in the US (2000).
- 75% of identified patients were admitted for malrotation; 25% had incidental findings during other abdominal surgeries.
- Complications included volvulus/ischemia (31 patients), intestinal resection (7), and one mortality.
Conclusions:
- The Ladd's procedure is supported for older children with incidentally found malrotation.
- Proactive surgical intervention can prevent severe, potentially devastating complications.
- This study provides crucial data for refining treatment strategies in pediatric surgical practice.
Purpose:
Because malrotation most commonly presents in infants, treatment recommendations for older children (>1 year) have been based on data obtained from small case series. The purpose of this study was to use a large national database to determine the clinical significance of older children presenting with malrotation to develop treatment recommendations for this group.
Methods:
Records of children undergoing a Ladd's procedure were identified in the Kids' Inpatient Database, an administrative database that contains all pediatric discharges from 27 states during 2000. Patient characteristics, associated diagnoses, operations performed, and mortality were evaluated. Discharge weighting was used to obtain a national estimate of the number of children older than 1 year treated for malrotation.
Results:
Two hundred nineteen older children (>1 and <18 years) undergoing a Ladd's procedure were identified in the database. One hundred sixty-four (75%) of these patients were admitted for treatment of malrotation, whereas most of the remaining 55 patients (25%) were admitted for another diagnosis and underwent a Ladd's procedure incidental to another abdominal operation. Seventy-five patients underwent a Ladd's procedure during an emergency admission. Thirty-one patients had volvulus or intestinal ischemia, 7 underwent intestinal resection, and 1 patient died. Based on case weightings, it was estimated that 362 older children underwent a Ladd's procedure for symptoms related to malrotation in 2000 in the United States (5.3 cases per million population).
Conclusions:
These findings provide support for performing a Ladd's procedure in older children with incidentally found malrotation to prevent the rare but potentially devastating complications of this anomaly.