Trends in adoption of laparoscopy for the Ladd's procedure: a multicenter analysis

We sought to evaluate contemporary trends in utilization of laparoscopy for the Ladd's procedure across 10 children's hospitals.

Pediatric patients ≤ 15 years of age with malrotation who underwent a Ladd's procedure across 10 children's hospitals between 1/2014 and 12/2020 were retrospectively reviewed. Patient demographics, preoperative imaging, and operative details were collected. The primary outcome was temporal change in the utilization of laparoscopy.

A total of 638 patients were included: laparoscopy was attempted in 182 (28.5%) and the remaining 456 (71.5%) were performed open. The median age of all patients was 3.0 months [IQR 0.3, 12.0] and median weight was 5.1 kg [IQR 3.3, 10.9]. From 2014 to 2020, attempted laparoscopic Ladd's increased from 19.6% to 40.3% (p = 0.007); conversion to open rates ranged from 27.3% to 41.9%. Among 504 patients without preoperatively diagnosed volvulus, laparoscopic Ladd's was attempted in 159 cases (31.5%) and completed laparoscopic in 108 (67.9%); conversion rates were stable over time (p = 0.895). Of 131 patients with preoperatively diagnosed volvulus, laparoscopic Ladd's was attempted in 22 cases (16.8%) and completed laparoscopically in 7 (31.8%); rates of conversion varied (p = 0.159).

Utilization of laparoscopy for the Ladd procedure is increasing for malrotation; however, conversion rates remain high and unchanged.