Related Experiment Videos
Simultaneous correction of malrotation and gastroesophageal reflux in infants
1Department of Surgery, Kaiser Permanente Medical Center, Los Angeles, California 90027, USA.
Insights
Concurrent surgical correction of gastrointestinal malrotation and gastroesophageal reflux (GER) in infants is effective. Combining the Ladd and Nissen procedures offers immediate symptom resolution with minimal added operative time and no increased morbidity.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Care
Background:
- Gastroesophageal reflux (GER) frequently co-occurs with gastrointestinal malrotation in infants.
- Current practice often involves primary malrotation repair, delaying GER treatment to avoid potential morbidity.
- This approach may lead to persistent GER symptoms requiring secondary intervention.
Purpose of the Study:
- To evaluate the efficacy and safety of concurrent surgical correction for infants with both GER and malrotation.
- To compare outcomes of simultaneous Ladd and Nissen procedures versus Ladd procedure alone followed by potential secondary antireflux surgery.
Main Methods:
- Retrospective review of 12 infants with GER and malrotation.
- Comparison between infants receiving concurrent Ladd and Nissen procedures (Group 1) and those treated with Ladd procedure alone (Group 2).
- A control group of 7 infants with malrotation only was included for operative time and recovery comparison.
Main Results:
- Infants in Group 1 experienced immediate resolution of GER and malrotation symptoms.
- Group 2 infants required subsequent antireflux procedures due to persistent symptoms despite medical management.
- Concurrent procedures added an average of 35 minutes to operative time with comparable postoperative recovery and hospital stays to controls.
Conclusions:
- Concurrent Ladd and Nissen procedures offer an expedient and effective treatment for infants with both GER and malrotation.
- This comprehensive approach minimizes the need for secondary surgeries and avoids increased morbidity.
- The combined procedure is recommended for improved patient outcomes.
Abstract:
Gastroesophageal reflux (GER) is often associated with gastrointestinal malrotation in infants. Primary correction of the malrotation, reserving a secondary antireflux procedure for those patients with persistent symptoms of GER, is most commonly practiced. This decision is based on the notion that an antireflux procedure may be unnecessary and is associated with added morbidity. We retrospectively reviewed 12 infants with GER and malrotation. All infants had symptoms attributed to GER and/or malrotation. A control group of seven infants with malrotation only was included for comparison of operative duration and postoperative recovery. Infants who received concurrent Ladd and Nissen procedures (Group 1, n=8) had immediate resolution of symptoms. Infants treated by Ladd procedure alone (Group 2, n=4), had persistent symptoms, despite postoperative medical therapy. A subsequent antireflux procedure was necessary. Comparison of operative times showed that a simultaneous procedure added, on average, 35 minutes to the Ladd procedure. Postoperative feeding and hospital stay were comparable between Group 1 and the control group. In contrast, Group 2 patients had longer hospitalizations due to ineffective medical therapy for persistent GER. No significant morbidity was noted. We recommend comprehensive surgical treatment with concurrent Ladd and Nissen procedures. This approach provides expedient and effective treatment of GER and malrotation, with minimal increase in operative time and no increase in morbidity .