Heterotaxy syndrome and intestinal rotational anomalies: Impact of the Ladd procedure
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Arash Salavitabar1, Brett R Anderson2, Gudrun Aspelund3
1Department of Pediatrics, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, 630W 168th St.-VC 507, New York, NY 10032, USA.
Insights
The Ladd procedure in infants with heterotaxy and intestinal rotational anomalies (IRA) was linked to a higher likelihood of subsequent adverse events. This finding suggests a need for careful consideration of prophylactic Ladd procedures in this vulnerable pediatric population.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Gastrointestinal Surgery
Background:
- Children with heterotaxy syndrome and intestinal rotational anomalies (IRA) face risks of midgut volvulus and ischemia.
- The prophylactic Ladd procedure's risks and benefits in these children remain debated.
- This study evaluates the impact of Ladd procedures on adverse events in pediatric patients with heterotaxy and IRA.
Purpose of the Study:
- To assess the impact of Ladd procedures on adverse events.
- To analyze the association between prophylactic Ladd procedures and subsequent morbidity in infants with heterotaxy and IRA.
Main Methods:
- Retrospective cohort study utilizing the Pediatric Health Information System (PHIS) database.
- Included infants diagnosed with heterotaxy and IRA, admitted at age ≤ 30 days, with a minimum 2-year follow-up.
- Primary outcome: major morbidity (intestinal obstruction/volvulus, ischemia, resection, or in-hospital mortality).
Main Results:
- 325 patients met inclusion criteria; 92 (28%) had single ventricles.
- Ladd procedure performed during initial hospitalization in 188 (58%) children.
- Multivariable analysis revealed Ladd procedure associated with 2.2 times increased odds of subsequent adverse events (95% CI 1.3-4.0, p = 0.007).
Conclusions:
- The Ladd procedure in infants with heterotaxy and IRA is associated with increased odds of adverse events.
- Findings suggest caution regarding prophylactic Ladd procedures in this patient group.
Background:
Children with heterotaxy syndrome and intestinal rotational anomalies (IRA) are at risk for midgut volvulus and ischemia. Controversy exists regarding risks and benefits of prophylactic Ladd procedures. The purpose of this study is to assess the impact of Ladd procedures on adverse events for children with heterotaxy and IRA.
Methods:
A retrospective cohort study using the Pediatric Health Information System (PHIS) database was performed. All children with heterotaxy and IRA admitted at age ≤ 30 days and discharged between 1/1/2004 and 1/1/2011 were included with a minimum 2-year follow-up period. The primary outcome was major morbidity, defined as a composite variable for intestinal obstruction/volvulus, ischemia, or resection, or inhospital mortality. Univariable and multivariable analyses were performed.
Results:
There were 325 patients who met the inclusion criteria, including 92 (28%) patients with single ventricles. Mean gestational age was 38.0 ± 2.1 weeks and birth weight was 3.1 ± 0.6 kg. Ladd procedure was performed during initial hospitalization on 188 (58%) children. In multivariable analyses, Ladd procedure on initial hospitalization was associated with a 2.2 times increased odds of adverse events on subsequent admissions (95% CI 1.3-4.0, p = 0.007).
Conclusions:
Ladd procedure is associated with increased odds of adverse events for children with heterotaxy and IRA.
