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Laparoscopic Ladd'S Procedure in Children: Challenges, Results, and Problems
A Suyodhan Reddy1, Rasik S Shah1,2, Dattaguru R Kulkarni1
1Department of Pediatric Surgery, Grant Medical College and Sir J.J. Hospital, Mumbai, Maharashtra, India.
Insights
Laparoscopic Ladd's procedure is a feasible option for treating intestinal malrotation in children, though some cases require conversion to open surgery or reoperation for symptom recurrence.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Intestinal malrotation in children presents surgical challenges.
- Laparoscopic correction of malrotation requires careful consideration of indications, outcomes, and potential complications.
Purpose of the Study:
- To review the authors' experience with laparoscopic correction of intestinal malrotation in pediatric patients.
- To evaluate the feasibility, success rates, and complications associated with the laparoscopic Ladd's procedure.
Main Methods:
- A retrospective analysis of 41 pediatric cases diagnosed with intestinal malrotation.
- Evaluation based on clinical and radiological findings.
Main Results:
- Successful laparoscopic Ladd's procedure in 35 cases, with 6 conversions to open surgery.
- Average hospital stay of 4 days and restoration of feeding by day 3.
- Nine cases experienced symptom recurrence, necessitating open surgery for re-intervention.
Conclusions:
- Laparoscopic Ladd's procedure is feasible for pediatric intestinal malrotation, with or without volvulus.
- Conversion to open surgery may be necessary due to anatomical challenges.
- Recurrent symptoms require reoperation, often due to incomplete correction or adhesions.
Background:
Laparoscopic correction of malrotation in children is challenging. Authors review their experience with indications, results and problems of laparoscopic correction of malrotation.
Materials And Methods:
This is a retrospective study of 41 cases of children who were diagnosed as Intestinal malrotation on clinical and radiological evaluation.
Results:
Successful laparoscopic Ladd's procedure was accomplished in 35 cases. There were six conversions to open surgery. The mean hospital stay was 4 days (range 3-12days). Restoration of complete feed was achieved on an average of 3 days (range 2-4days). Post-operative recurrence of symptoms was seen in nine cases. Of which, five cases had incomplete correction, three cases had duodenal kinking due to adhesive intestinal obstruction and one had intra luminal duodenal obstruction. All patients underwent open surgery for recurrent symptoms.
Conclusion:
Laparoscopic Ladd's procedure is feasible in children with intestinal malrotation with or without associated volvulus. However, some of them need conversion to open surgery due to difficult local anatomy. For persistent symptoms, they may require redo surgery, which may be due to incomplete correction, adhesive obstruction or intraluminal obstruction.