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Long-term complications following intestinal malrotation and the Ladd's procedure: a 15 year review
Feilim Liam Murphy1, Anthony L Sparnon
1Department of Paediatric Surgery, Women's and Children's Hospital, 72 King William Road, Adelaide, SA, Australia. feilimmurphy@ireland.com
Insights
Children undergoing surgery for intestinal malrotation face significant long-term health issues, including a high risk of bowel obstruction. Parents need thorough education on potential complications after surgical correction.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Outcomes Research
Background:
- Intestinal malrotation necessitates urgent surgical intervention in children.
- Long-term sequelae and complications following surgical correction of intestinal malrotation are not well-understood.
- This study investigates the long-term impact of surgically corrected intestinal malrotation on patient quality of life.
Purpose of the Study:
- To assess the long-term morbidity and quality of life in children treated for intestinal malrotation.
- To identify the frequency and nature of late complications after surgical correction.
- To inform parental education regarding potential risks.
Main Methods:
- Retrospective review of 46 children who underwent surgery for intestinal malrotation over 15 years.
- Inclusion of patient chart review and direct patient contact for follow-up.
- Analysis of complications, readmissions, and further surgical interventions.
Main Results:
- Nearly half (46%) of patients experienced complications post-surgery.
- Significant rates of readmission (26%) within six months, with 24% due to acute bowel obstruction.
- 13% required further surgery for adhesion-related obstruction; 9% mortality overall (one related to obstruction).
Conclusions:
- Surgically corrected intestinal malrotation is associated with substantial long-term morbidity.
- Small bowel obstruction is a significant late complication requiring parental awareness.
- Enhanced patient and parental education is crucial for managing expectations and potential risks.
Background:
It is accepted that children with volvulus require urgent surgery. However the long term sequelae and late complications of its surgical therapy are less well understood. We hypothesised that the surgical corrected intestinal malrotation have significant long term impact on the patients quality of life.
Methods:
Forty-six children with intestinal malrotation were operated on at a tertiary referral centre over a fifteen year period. Their charts were retrospectively reviewed and the patients were contacted.
Results:
The study revealed two distinct groups, those without complications 25 (54%) and those without 21 (46%). In the acute post operative period four (9%) patients had on going feeding difficulties and one (2%) developed chronic abdominal pain. However 12 (26%) required readmission within the first six months after the initial operation. Eleven (24%) patients were readmitted with acute bowel obstruction. Six (13%) patients required multiple admissions due to small bowel obstruction and six (13%) patients underwent further surgery for adhesion related obstruction. There were four (9%) deaths in the study group, three due to other medical conditions and one following small bowel obstruction. There was zero mortality immediately after the primary operation. There was no significant difference in the initial presentation, age and operative findings in those requiring further surgery and those who did not.
Conclusions:
We demonstrated that there is a significant long-term morbidity associated with intestinal malrotation even after corrective surgery. Detailed education about the potential for small bowel obstruction must be given to the parents of these children.