Surgery for suspected rotation abnormality: selection of open vs laparoscopic surgery using a rational approach

Laparoscopy is increasingly used for children with suspected rotation abnormalities. However, indications for open and laparoscopic approaches are not well defined. We reviewed our experience with both open and laparoscopic approaches to develop a rational approach to these patients.

Charts of all children undergoing surgery for a suspected rotation abnormality for 10 years were retrospectively reviewed.

There were 173 patients. Of 73 neonates presenting with suspected volvulus, 71 underwent initial laparotomy and 2 were converted from initial laparoscopy. Eighty percent underwent Ladd procedure, 64% had volvulus, and 2 died of midgut volvulus. Of 18 neonates presenting without suspected volvulus, 14 underwent initial laparotomy and 4 had a laparoscopic approach with 1 conversion to laparotomy. Seventy-eight percent underwent Ladd procedure, and 22% had volvulus. Of the 82 older patients, 37 underwent laparotomy and 45 had initial laparoscopy, 8 of which were converted. Sixty-seven percent underwent Ladd procedure, and 28% had volvulus. Postoperative complication rate, median time to full diet, and median hospital stay were comparable with those previously reported in the literature.

Based on our results, we advocate open surgery for neonates with suspected volvulus. Laparoscopy represents an excellent alternative for older children and for neonates presenting without suspected volvulus.