Multicenter Long-Term Outcomes of Laparoscopic Versus Open Ladd's Procedure for Intestinal Malrotation

The Ladd's procedure is the surgical treatment for symptomatic intestinal malrotation in children. Although laparoscopic techniques have gained popularity, there is concern that it may lead to decreased adhesion formation and thus increased susceptibility to volvulus. This study examined long-term outcomes of laparoscopic versus open Ladd's procedure.

Retrospective review was conducted of 281 patients who underwent Ladd's procedure at a large integrated healthcare system from 2010 - 2024. Choice of technique (laparoscopic or open) was based on surgeon preference. 109 patients met inclusion criteria for this study. Exclusion criteria included prior abdominal surgery or intra-abdominal pathology such as gastroschisis, omphalocele or duodenal atresia.

Among the 109 patients, 73 (67.0%) underwent open surgery and 36 (33.0%) underwent laparoscopic surgery. Patients who underwent open Ladd's procedure had a reoperation rate of 9.6% (7/73) compared to 5.6% (2/36) in the laparoscopic group (OR 1.75, 95% CI 0.34-8.90; P = 0.72). Fourteen cases were converted laparoscopic to open. Within the open cohort, one patient required reoperation for volvulus and six for small bowel obstruction (SBO). Within the laparoscopic cohort, two patients required reoperation for SBO. The mean time from index operation to future surgery was 1.8 years (6 days-10.1 years).

There was no increased risk of volvulus and a trend towards decreased risk of SBO with laparoscopic Ladd's procedure. Although more technically challenging, these findings may support the safety and long-term benefits of laparoscopic Ladd's procedure and suggest it can be considered as the initial treatment when feasible.