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Laparoscopic Ladd's procedure in infants with malrotation
K D Bass1, S S Rothenberg, J H Chang
1Presbyterian St Luke's Columbia Medical Center and The Children's Hospital, Denver, CO, USA.
Insights
Laparoscopic Ladd's procedure is a safe and effective surgical option for treating intestinal malrotation in infants. This minimally invasive technique offers comparable operative times to open surgery, with faster feeding and shorter hospital stays.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Intestinal malrotation is a congenital anomaly requiring surgical correction.
- Traditional open surgery for malrotation can involve significant recovery times.
- Laparoscopic techniques offer potential benefits in pediatric surgical procedures.
Purpose of the Study:
- To evaluate the feasibility of a laparoscopic approach for treating documented intestinal malrotation.
- To assess the safety and efficacy of the laparoscopic Ladd's procedure in neonates and infants.
Main Methods:
- A prospective study involving 12 patients (5 days to 4 months old) with symptomatic malrotation.
- Laparoscopic Ladd's procedure performed using three 3.5 mm trocars.
- Standard Ladd's procedure with appendectomy was completed in all cases.
Main Results:
- All laparoscopic procedures were successfully completed with an average operative time of 58 minutes.
- No surgical complications were reported; all patients experienced symptom resolution.
- Early feeding (POD 1 or 2) and short hospital stays (average 2.2 days) were observed.
Conclusions:
- Laparoscopic Ladd's procedure is a safe and effective treatment for intestinal malrotation.
- The technique is feasible in neonates and infants, comparable to open surgery.
- Laparoscopic approach facilitates earlier feeding and reduced hospital stays.
Purpose:
This clinical study was undertaken to examine the feasibility of a laparoscopic approach for the treatment of documented malrotation.
Methods:
From May 1994 through January of 1997, 12 patients, aged 5 days to 4 months, weighing 3 to 7 kg, underwent laparoscopic Ladd's procedure for malrotation. All patients had symptoms of intermittent upper intestinal obstruction, and malrotation was documented by an upper gastrointestinal contrast study. None of the patients had acute volvulus or compromised bowel. The procedure was performed using 3 trocars of 3.5 mm diameter. Ports were placed in the infraumbilical ring, and the right and left mid to lower quadrants. A standard Ladd's procedure with appendectomy was performed in all cases.
Results:
All procedures were completed successfully through the laparoscope. Operative times averaged 58 minutes (35 to 120 minutes). One patient with Pierre-Robin underwent a laparoscopic Nissen fundoplication and gastrostomy tube placement at the same time requiring 120 minutes. Feedings were started on postoperative day (POD) 1 in 10 cases and POD 2 in two cases. Hospital stay ranged from 2 to 4 days (average, 2.2) in the patients with isolated malrotation. The patient with Pierre-Robin had a prolonged hospitalization because of chronic respiratory problems not associated with surgery. There were no complications. All patients had resolution of their symptoms.
Conclusions:
Laparoscopic Ladd's procedure is a safe and effective technique. It can be performed in neonates in times equivalent to standard open techniques, and it appears to allow for earlier feeds and decreased hospital stays.