Evaluating a management strategy for malrotation in heterotaxy patients
Paulette I Abbas1, Heather A Dickerson2, David E Wesson1
1Division of Pediatric Surgery, Houston, TX, United States; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States.
Journal of Pediatric Surgery
|March 13, 2016
Summary
Management of malrotation in children with heterotaxy and congenital heart disease (CHD) is debated. A Ladd procedure led to 11% small bowel obstruction (SBO) readmissions, while observation prevented volvulus in this study.
Area of Science:
- Pediatric Surgery
- Congenital Abnormalities
- Gastrointestinal Surgery
Background:
- Malrotation in children with heterotaxy and congenital heart disease (CHD) presents management challenges.
- Existing literature lacks consensus on optimal treatment strategies for this complex patient group.
Purpose of the Study:
- To compare outcomes of surgical Ladd procedure versus observation for malrotation in pediatric patients with heterotaxy and CHD.
- To evaluate readmission rates for small bowel obstruction (SBO) or volvulus.
Main Methods:
- Retrospective review of 88 pediatric patients with heterotaxy, malrotation, and CHD treated between 2002 and 2014.
- Analysis of primary outcomes including readmission for SBO or volvulus.
Main Results:
- 68 patients underwent a Ladd procedure; 11% (6/56) surviving patients were readmitted with SBO, 2 requiring surgery.
- 20% of all patients died from cardiopulmonary complications.
- None of the 12 observed patients developed volvulus.
Conclusions:
- The Ladd procedure for malrotation in heterotaxy/CHD patients is associated with an 11% rate of SBO complications.
- Observation of malrotation in this cohort resulted in no instances of volvulus.
- Complication rates suggest observation may be a safer approach than surgical intervention in select cases.
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