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Laparoscopic Ladd's procedure for intestinal malrotation in small infants with midterm follow-up
Xuepeng Zhang1,2, Lvna Xiang3, Tong Qiu1
1Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
Insights
Laparoscopic Ladd's procedure (LL) is a safe and effective treatment for intestinal malrotation (IM) in infants, offering shorter recovery times compared to open surgery. This minimally invasive approach leads to reduced hospital stays and faster feeding resumption.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Intestinal malrotation (IM) is a congenital condition requiring surgical correction.
- Ladd's procedure is the standard surgical intervention for IM.
- Evaluating minimally invasive techniques like laparoscopic Ladd's procedure (LL) is crucial for improving outcomes in infants.
Purpose of the Study:
- To assess the safety and efficacy of laparoscopic Ladd's procedure (LL) for treating intestinal malrotation (IM) in infants.
- To compare the outcomes of LL with the traditional open Ladd's operation (OL).
Main Methods:
- Retrospective review of 55 infants under 6 months with IM who underwent either LL or OL between 2012 and 2019.
- Comparison of perioperative data, including operative time, time to full feed (TFF), and postoperative hospital stay (PHS).
- Analysis of complication rates, including volvulus, adhesive obstruction, recurrence, and reoperation.
Main Results:
- No significant difference in operative time or volvulus rates between LL and OL groups.
- LL group demonstrated significantly shorter TFF (3.1 vs. 7.3 days) and PHS (5.5 vs. 11.3 days) compared to OL.
- Similar rates of overall postoperative complications and reoperation between the two groups.
- LL showed a trend towards lower adhesive obstruction rates (0% vs. 11.8%) and recurrence (4.8% vs. 0.0%), though not statistically significant.
Conclusions:
- Laparoscopic Ladd's procedure (LL) is a safe and reliable surgical option for IM in infants.
- LL offers significant advantages over OL, including shorter time to full feed and reduced hospital stay.
- The procedure is associated with satisfactory cosmetic results and comparable safety profiles.
Background:
The objective of this study was to evaluate the safety and efficacy of laparoscopic Ladd's procedure (LL) for intestinal malrotation (IM) in small infants.
Methods:
All patients aged < 6 months with IM who underwent Ladd's procedures between January 2012 and December 2019 were enrolled. The perioperative demographics and midterm follow-up results were retrospectively reviewed and compared between patients who underwent LL and open Ladd's operation (OL).
Results:
Fifty-five patients were enrolled for analysis. The baseline characteristics were well matched in the two groups. The rate of volvulus was similar in the two groups (76.2% vs. 73.5%, P = 0.81). Two cases in the LL group were converted to OL due to intraoperative bleeding and intestinal swelling. The operative time (ORT) was not significantly different between the two groups (73.8 ± 18.7 vs. 66.8 ± 11.6 min, P = 0.76). Compared to the OL group, the LL group had a shorter time full feed (TFF) (3.1 ± 1.2 vs. 7.3 ± 1.9 days, P = 0.03) and a shorter postoperative hospital stay (PHS) than the OL group (5.5 ± 1.6 vs. 11.3 ± 2.7 days, P = 0.02). The rate of postoperative complications was similar in the two groups (9.5% vs. 11.8%, P = 0.47). The LL group had a lower rate of adhesive obstruction than the OL group, but the difference was not significant (0.0% vs. 11.8%, P = 0.09). One patient suffered recurrence in the LL group, while 0 patients suffered recurrence in the OL group (4.8% vs. 0.0%, P = 0.07). The rate of reoperation in the two groups was similar (4.8% vs. 8.8%).
Conclusions:
The LL procedure for IM in small infants was a safe and reliable method that had a satisfactory cosmetic appearance and shorter TFF and PHS than OL.
