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Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
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Prone Lateral Minimally Invasive Retropleural Corpectomy Using a Rotatable Radiolucent Jackson Table
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Prophylactic versus symptomatic Ladd procedures for pediatric malrotation.

Sarah E Covey1, Luke R Putnam2, Kathryn T Anderson2

  • 1Department of Pediatric Surgery, Center for Surgical Trials and Evidence-Based Practice, Houston, Texas.

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|September 25, 2016
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Summary

Prophylactic Ladd procedures in infants with intestinal malrotation may reduce reoperations and complications compared to symptomatic treatment. Further prospective studies are needed to confirm benefits for asymptomatic patients.

Keywords:
Intestinal malrotationLadd procedureVolvulus

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Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Surgical Outcomes

Background:

  • Intestinal malrotation can lead to life-threatening volvulus, necrosis, and sepsis.
  • The Ladd procedure is the standard treatment for symptomatic malrotation.
  • The necessity and timing of intervention for asymptomatic infants remain debated.

Purpose of the Study:

  • To evaluate the outcomes of prophylactic Ladd procedures in asymptomatic infants with intestinal malrotation.
  • To compare complication rates and recovery times between prophylactic and symptomatic Ladd procedures.

Main Methods:

  • Retrospective review of pediatric patients undergoing the Ladd procedure between 2011-2014.
  • Identification of prophylactic Ladd procedures performed before symptom onset.
  • Statistical analysis using student t test, Mann-Whitney U, and chi-squared tests.

Main Results:

  • 42 patients underwent the Ladd procedure (19 prophylactic, 23 symptomatic).
  • No prophylactic Ladd procedure patients required reoperation, versus 26% of symptomatic patients (P=0.02).
  • Symptomatic patients had higher rates of volvulus (39%) and necrosis (4.3%) at surgery.

Conclusions:

  • Prophylactic Ladd procedures may be beneficial in infants with known malrotation, potentially reducing postoperative complications.
  • Symptomatic patients, despite being sicker, experienced higher complication rates.
  • A larger, prospective study is warranted to confirm the effectiveness of prophylactic Ladd procedures.