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Laparoscopic Ladd's procedure for malrotation in infants and children is still a controversial approach
Alexis Pierre Arnaud1, Etienne Suply1, Simon Eaton2
1Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, NHS Foundation Trust, London, UK.
Insights
Laparoscopic Ladd's procedure for intestinal malrotation is reliable, with a redo surgery rate comparable to open surgery. Early conversion to open surgery is important, especially in cases with midgut volvulus.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
Background:
- Open Ladd's procedure is the standard for intestinal malrotation.
- The laparoscopic approach for malrotation correction is debated.
Purpose of the Study:
- To evaluate the feasibility and outcomes of laparoscopic management of intestinal malrotation.
- To compare laparoscopic outcomes with open Ladd's procedure.
Main Methods:
- A single-center retrospective study (2007-2017) of 65 patients undergoing laparoscopic assessment for intestinal malrotation.
- Level III retrospective comparative treatment study.
Main Results:
- Laparoscopic Ladd's procedure was completed in 86% of patients.
- Symptomatic patients, including 25% with midgut volvulus, were treated.
- Morbidity was 15%, with a 6% redo surgery rate, similar to open Ladd's.
Conclusions:
- Laparoscopic Ladd's procedure is a reliable option for intestinal malrotation.
- Conversion to open surgery may be influenced by a learning curve and is crucial for volvulus cases.
- The redo surgery rate is comparable to the open approach.
Background:
Open Ladd's procedure is the gold standard for the correction of intestinal malrotation and laparoscopic approach remains controversial. This study aimed to evaluate our experience in laparoscopic management of malrotation.
Methods:
Single center retrospective study including patients who underwent a laparoscopic assessment of intestinal malrotation with correction if appropriate between 2007 and 2017.
Results:
Sixty-five patients (median age 7 months) had a laparoscopic assessment with and without correction of malrotation. Forty-five (69%) were symptomatic, including 16 (25%) with a midgut volvulus. The procedure was completed laparoscopically in 55 (86%) patients in 110 min (30-190). Conversions happened more frequently at the beginning of the experience. With a follow-up of 12.5 months (8 days-5.3 years), morbidity rate was 15% and 4 (6%) patients underwent a redo surgery, all in the first 5 months after surgery, compared with 3/53 (6%) in a contemporaneous group undergoing open Ladd's.
Conclusion:
This is the largest series reported so far of the laparoscopic management of malrotation. Laparoscopic Ladd's procedure is reliable but still exposes to open conversion which may be in part owing to a learning curve. A low conversion threshold is important in cases with volvulus. The redo rate is similar to that of the open procedure.
Level Of Evidence:
Level III retrospective comparative treatment study.
