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Outcomes for Ladd's procedure: Does approach matter?

Rebecca A Saberi¹, Gareth P Gilna¹, Blaire V Slavin²

¹DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.

Journal of Pediatric Surgery

|October 18, 2021

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Laparoscopic Ladd's procedure for malrotation is underutilized in the U.S. Open Ladd's procedures result in longer hospital stays and more complications, though readmission rates are similar for both approaches.

Area of Science:

Pediatric Surgery
Gastrointestinal Surgery
Minimally Invasive Surgery

Background:

Laparoscopic Ladd's procedure is a safe and effective treatment for intestinal malrotation.
Nationwide data on the utilization and outcomes of elective Ladd's procedure are limited.

Purpose of the Study:

To evaluate the national utilization patterns of laparoscopic versus open Ladd's procedure for malrotation.
To compare patient demographics, hospital factors, and clinical outcomes between laparoscopic and open approaches.

Main Methods:

Analysis of the Nationwide Readmissions Database (2010-2014) for patients aged 0-18 undergoing elective Ladd's procedure for malrotation.
Comparison of laparoscopic versus open approaches using statistical tests and propensity score-matched analysis.

Keywords:

Ladd's procedure Laparoscopic Malrotation Readmissions Volvulus

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Weighted analysis to provide national estimates of utilization and outcomes.

Main Results:

The majority of elective Ladd's procedures (78%) were performed via an open approach, despite comparable outcomes.
The laparoscopic approach was associated with shorter hospital stays and fewer post-operative gastrointestinal issues.
Readmission rates were similar between approaches (7% laparoscopic vs. 16% open), with lower rates of gastrointestinal issues on readmission for the laparoscopic group.

Conclusions:

Open Ladd's procedure remains the predominant approach in the U.S. for malrotation treatment.
Laparoscopic Ladd's procedure offers comparable outcomes to the open approach with potential benefits in reducing complications.
Readmission rates and the need for redo Ladd's procedure are low and similar between both surgical approaches.