Comparing laparoscopic versus open Ladd's procedure in pediatric patients

Area of Science:

• Minimally Invasive Surgery
• Pediatric Surgery
• Gastrointestinal Surgery

Background:

• Intestinal malrotation is a congenital condition requiring surgical correction.
• Ladd's procedure is the standard surgical intervention for intestinal malrotation.
• Comparative data on laparoscopic versus open Ladd's procedure outcomes are limited.

Purpose of the Study:

• To compare 30-day postoperative outcomes between laparoscopic and open Ladd's procedures.
• To evaluate the efficacy and safety of laparoscopic Ladd's procedure in pediatric patients.
• To identify potential advantages of minimally invasive approaches in treating intestinal malrotation.

Main Methods:

• Retrospective analysis of the 2013-2014 National Surgical Quality Improvement Program Pediatric database.
• Inclusion of all elective Ladd's procedures for intestinal malrotation.
• Propensity score-matched analysis and generalized estimating equations (GEEs) for outcome comparison.

Main Results:

• Laparoscopic Ladd's procedure was associated with significantly shorter total length of stay (4 days) and postoperative length of stay (4 days) compared to open Ladd's (6 and 5 days, respectively).
• Postoperative complication rates (9.4% vs. 20.9%) and need for hospitalization beyond 30 days (1.9% vs. 9.3%) were lower in the laparoscopic group, though not statistically significant.
• The study included 53 laparoscopic and 86 open cases after propensity score matching.

Conclusions:

• Laparoscopic Ladd's procedure demonstrates short-term benefits, including reduced hospital stay, compared to the open approach.
• Further multi-institutional studies are recommended to investigate long-term outcomes and solidify the advantages of laparoscopic Ladd's procedure.
• Findings support the consideration of laparoscopic Ladd's procedure for intestinal malrotation management.