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Laparoscopic Versus Open Ladd's Procedure for Intestinal Malrotation in Infants and Children: A Systematic Review and
Zhiyi Zhang1, Yajun Chen1, Jiayu Yan1
1Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China.
Insights
Laparoscopic Ladd's procedure for intestinal malrotation in children offers shorter operative times, hospital stays, and faster feeding compared to open surgery. However, it may increase the risk of postoperative volvulus, requiring further research.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Intestinal malrotation with midgut volvulus is a surgical emergency in infants and children.
- Ladd's procedure is the standard surgical correction for intestinal malrotation.
- Laparoscopic approaches are increasingly adopted, but their comparative efficacy to open surgery requires robust evidence.
Purpose of the Study:
- To compare the clinical outcomes of laparoscopic versus open Ladd's procedure for intestinal malrotation in pediatric patients.
- To evaluate key metrics including operative time, recovery, and postoperative complications.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials and retrospective studies.
- Searched PubMed, EMBASE, and Cochrane Library for studies comparing laparoscopic and open Ladd's procedure up to January 5, 2021.
- Analyzed outcomes such as operative time, time to full feeds, hospital stay, reoperation rates, and complications.
Main Results:
- The laparoscopic group showed significantly shorter operative times (MD = -14.44 min), hospital stays (MD = -4.57 days), and time to full feeds (MD = -3.00 days).
- Laparoscopic Ladd's resulted in fewer overall postoperative complications (OR = 0.35) and less adhesive small bowel obstruction (OR = 0.37).
- A higher incidence of postoperative volvulus was observed in the laparoscopic group (OR = 2.97), with no significant difference in reoperation rates.
Conclusions:
- Laparoscopic Ladd's procedure demonstrates superiority over open surgery in terms of operative efficiency and early recovery.
- The increased risk of postoperative volvulus with laparoscopy warrants careful consideration and further investigation.
- Additional randomized controlled trials with extended follow-up are necessary to fully elucidate long-term outcomes and optimize surgical strategies.
Abstract:
To compare clinical outcomes in infants and children with intestinal malrotation who were treated by laparoscopic or open Ladd's. PubMed, EMBASE, and Cochrane library were searched for studies comparing laparoscopy with open Ladd's for intestinal volvulus through January 5, 2021. Search terms were confined to Title/Abstract: "Intestinal Volvulus" OR "Intestinal malrotation" AND "Laparoscopy" AND "Laparotomy." Randomized controlled trials (RCTs) and retrospective studies comparing laparoscopy with open Ladd's in neonates, infants, or children were included. Outcomes evaluated included operative time, time to full feeds, length of hospital stay, rate of conversion, reoperation, overall postoperative complications, postoperative adhesive small bowel obstruction, and postoperative volvulus. Pooled odds ratios (OR) were calculated for dichotomous variables; pooled mean differences (MDs) were measured for continuous variables. Fourteen studies were included, comprising 444 patients who underwent laparoscopic approach and 1422 patients who underwent open procedure. Laparoscopy group had shorter operative time (MD = -14.44 minutes, 95% confidence interval [CI] = -20.79 to -8.09, P < .00001), hospital stay (MD = -4.57 days, 95% CI = -7.58 to -1.56, P = .003), and time to full feeds (MD = -3.00 days, 95% CI = -3.80 to -2.19, P < .00001). Laparoscopic Ladd's procedure had less overall postoperative complications (OR = 0.35, 95% CI = 0.19-0.65, P = .0009), less postoperative adhesive small bowl obstruction (OR = 0.37, 95% CI = 0.19-0.74, P = .005), and more postoperative volvulus (OR = 2.97, 95% CI = 1.23-7.13, P = .02). There was no difference in incidence of reoperation rate (OR = 2.04, 95% CI = 0.96-4.33, P = .06). Laparoscopic procedure is superior to open Ladd's in operative time, hospital stay, time to full feeds, overall postoperative complication, and postoperative adhesive small bowel obstruction. However, more RCTs with adequate follow-up are needed to overcome the limitations of our study.
