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Malrotation: Age-Related Differences in Reoperation Rate.
Arimatias Raitio1, Patrick A Green1, David W Fawkner-Corbett1
1Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, Merseyside, United Kingdom.
Summary
Surgery for intestinal malrotation in older children leads to a higher reoperation rate compared to infants. A duodenal bypass may be considered for chronic obstruction in older children.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Outcomes Research
Background:
- Intestinal malrotation typically presents in neonates but is often diagnosed later in childhood or adulthood.
- Delayed diagnosis of intestinal malrotation is linked to increased morbidity.
- Surgical complexity and outcomes in older children with malrotation require further investigation.
Purpose of the Study:
- To investigate the hypothesis that surgery for intestinal malrotation in older children is associated with increased morbidity compared to infants.
- To compare emergency reoperation rates, need for bypass procedures, and mortality between infant and older children undergoing malrotation surgery.
Main Methods:
- Retrospective analysis of 131 children (infants < 1 year, older children > 1 year) with intestinal malrotation undergoing laparotomy between 2002 and 2014.
- Primary outcome: emergency reoperation rate.
- Secondary outcomes: requirement for bypass at reoperation and mortality.
Main Results:
- Older children had a significantly higher emergency reoperation rate (7/27) compared to infants (6/104).
- Bypass procedures were more frequently required in older children (4/27) than infants (2/104).
- Mortality occurred in 3 patients (2.3%), all in the infant group, with one directly related to malrotation.
Conclusions:
- Surgical management of intestinal malrotation in older children is associated with a higher risk of emergency reoperation.
- Consideration of a primary duodenal bypass procedure is recommended for older children with chronic intermittent obstruction due to malrotation, especially if the standard Ladd procedure is insufficient.
