1
|
Gomaa IA, Mirande MD, Armenia SJ, Aboelmaaty S, Dozois EJ, Perry WRG. Intestinal malrotation in the adult population: Diagnosis, management, and outcomes after laparoscopic Ladd procedure. J Gastrointest Surg 2024; 28:1339-1343. [PMID: 38825442 DOI: 10.1016/j.gassur.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/18/2024] [Accepted: 05/21/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND The Ladd procedure is the treatment of choice for patients with intestinal malrotation; however, the long-term outcomes of the laparoscopic Ladd procedure are not well documented. This study aimed to review the presentation, management, and outcomes of adult patients who underwent a laparoscopic Ladd procedure. METHODS A retrospective review was conducted to identify adult patients with malrotation who underwent a laparoscopic Ladd procedure between January 1995 and June 2022 at the Mayo Clinic in Rochester, Minnesota. Patient details and follow-up data were obtained from the electronic medical records. Patients were invited to participate in a structured phone interview to assess symptoms and quality of life (QoL). RESULTS A total of 44 patients underwent the laparoscopic Ladd procedure. Of the 44 patients, 42 (95.5 %) were symptomatic, with 7 (16.7 %) presenting with acute symptoms. Moreover, 8 laparoscopic procedures (13.6 %) required conversion to an open procedure. The median estimated blood loss was 20 mL (IQR, 10-50), operative time was 2.3 h (IQR, 1.8-2.8), and hospital length of stay was 2 days (IQR, 2-3). Postoperative ileus was the most common complication (18.0 %). The median follow-up was 8.00 years (IQR, 2.25-13.00), with more than 90.0 % of patients having partial or complete symptom resolution. Of note, 28 patients (63.6 %) completed phone interviews. Moreover, 1 patient (2.0 %) reported a postoperative volvulus. When asked to compare their current symptoms with those preoperatively, 78.6 % of patients noted that they were significantly better. Furthermore, 85.7 % of patients reported that their QoL was significantly better after surgery. Finally, 96.4 % of patients would recommend the procedure to a friend or family member with the same condition. CONCLUSION The laparoscopic Ladd procedure is a safe and effective surgical procedure for adult patients with intestinal malrotation.
Collapse
Affiliation(s)
- Ibrahim A Gomaa
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, United States
| | | | - Sarah J Armenia
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
| | - Sara Aboelmaaty
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, United States
| | - Eric J Dozois
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, United States
| | - William R G Perry
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, United States.
| |
Collapse
|
2
|
Zhang X, Xiang L, Qiu T, Zhou J, Che G, Ji Y, Xu Z. Laparoscopic Ladd's procedure for intestinal malrotation in small infants with midterm follow-up. BMC Gastroenterol 2023; 23:402. [PMID: 37986145 PMCID: PMC10659069 DOI: 10.1186/s12876-023-03046-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Xuepeng Zhang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lvna Xiang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Tong Qiu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jiangyuan Zhou
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yi Ji
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Zhicheng Xu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
| |
Collapse
|
3
|
Sghaier A, Dhouioui K, Fradi K, El Ghali A, Hamila F, Youssef S. Recurrent caecal volvulus in an adult: Should we practice coecopexy systematically at neonatal age for incomplete common mesentery? A case report. Int J Surg Case Rep 2023; 108:108409. [PMID: 37336175 PMCID: PMC10382719 DOI: 10.1016/j.ijscr.2023.108409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Malrotation is usually revealed early in infancy and or later in childhood, even more unusually in adulthood. This disorder is treated through Ladd's procedure. Literature is limited on the long-term outcomes of this approach, especially into adulthood. CASE PRESENTATION We present a case of a 33 years male with a history of a laparotomy as a new born for a bowel obstruction secondary to malrotation, presenting with an obstruction and colonic volvulus. Laparotomy reveals a volvulus of the coecum secondary to a failure of the coecum to attach during surgery performed at neonatal age. CLINICAL DISCUSSION For a patient operated on during the neonatal period for intestinal malrotation, the examination for sub occlusive episodes should suggest a recurrence of malrotation such as coecal volvulus, and the possibility of technical malfunction during the previous procedure. This reflection leads us to consider the necessity of performing coecopexy systematically during the first surgery. CONCLUSION Ladd's technique is the surgical treatment of the incomplete common mesentery. The fixation of the coecum could be done in a systematic way to prevent a possible coecal volvulus which can be responsible for digestive necrosis and often even a fulminant evolution.
Collapse
Affiliation(s)
- Asma Sghaier
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia.
| | - Khairi Dhouioui
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia
| | - Khalil Fradi
- Hospital of Farhat Hached of Sousse, Tunisia; Department of General Surgery, Tunisia
| | - Amine El Ghali
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia
| | - Fehmi Hamila
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia
| | - Sabri Youssef
- Hospital of Farhat Hached of Sousse, Tunisia; Faculty of Medicine of Sousse, University of Sousse, Tunisia; Department of General Surgery, Tunisia
| |
Collapse
|
4
|
Huerta CT, Saberi RA, Lynn R, Ramsey WA, Gilna GP, Parreco JP, Sola JE, Perez EA, Thorson CM. Outcomes after Ladd Procedures for Intestinal Malrotation in Newborns with Heterotaxy Syndrome. J Pediatr Surg 2023; 58:1095-1100. [PMID: 36941169 DOI: 10.1016/j.jpedsurg.2023.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/09/2023] [Indexed: 02/19/2023]
Abstract
PURPOSE Intestinal malrotation may be asymptomatic in patients with heterotaxy syndrome (HS), and whether these newborns benefit from prophylactic Ladd procedures is unknown. This study sought to uncover nationwide outcomes of newborns with HS receiving Ladd procedures. METHODS Newborns with malrotation were identified from the Nationwide Readmission Database (2010-2014) and stratified into those with and without HS utilizing ICD-9CM codes for situs inversus (759.3), asplenia or polysplenia (759.0), and/or dextrocardia (746.87). Outcomes were analyzed using standard statistical tests. RESULTS 4797 newborns with malrotation were identified, of which 16% had HS. Ladd procedures were performed in 70% overall and more common in those without heterotaxy (73% vs. 56% HS). Ladd procedures in newborns with heterotaxy were associated with higher complications compared to those without HS including surgical site reopening (8% vs. 1%), sepsis (9% vs. 2%), infections (19% vs. 11%), venous thrombosis (9% vs. 1%), and prolonged mechanical ventilation (39% vs. 22%), all p < 0.001. HS newborns were less frequently readmitted with bowel obstructions (0% vs. 4% without HS, p < 0.001) with no readmissions for volvulus in either group. CONCLUSION Ladd procedures in newborns with heterotaxy were associated with increased complications and cost without differences in rates of volvulus and bowel obstruction on readmission. TYPE OF STUDY Retrospective Comparative. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Carlos Theodore Huerta
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rebecca A Saberi
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Royi Lynn
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Walter A Ramsey
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gareth P Gilna
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua P Parreco
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan E Sola
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eduardo A Perez
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad M Thorson
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| |
Collapse
|
5
|
Gil LA, Asti L, Apfeld JC, Sebastião YV, Deans KJ, Minneci PC. Perioperative outcomes in minimally-invasive versus open surgery in infants undergoing repair of congenital anomalies. J Pediatr Surg 2022; 57:755-762. [PMID: 35985848 DOI: 10.1016/j.jpedsurg.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 07/22/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study compared perioperative outcomes among infants undergoing repair of congenital anomalies using minimally invasive (MIS) versus open surgical approaches. METHODS The ACS NSQIP Pediatric (2013-2018) was queried for patients undergoing repair of any of the following 9 congenital anomalies: congenital lung lesion (LL), mediastinal mass (MM), congenital malrotation (CM), anorectal malformation (ARM), Hirschsprung disease (HD), congenital diaphragmatic hernia (CDH), tracheoesophageal fistula (TEF), hepatobiliary anomalies (HB), and intestinal atresia (IA). Inverse probability of treatment weights (IPTW) derived from propensity scores were utilized to estimate risk-adjusted association between surgical approach and 30-day outcomes. RESULTS 12,871 patients undergoing congenital anomaly repair were included (10,343 open; 2528 MIS). After IPTW, MIS was associated with longer operative time (difference; 95% CI) (16 min; 9-23) and anesthesia time (13 min; 6-21), but less postoperative ventilation days (-1.0 days; -1.4- -0.6) and shorter postoperative length of stay (-1.4 days; -2.4- -0.3). MIS repairs had decreased risk of any surgical complication (risk difference: -6.6%; -9.2- -4.0), including hematologic complications (-7.3%; -8.9- -5.8). There was no significant difference in risk of complication when hematologic complications were excluded (RD -2.3% [-4.7%, 0.1%]). There were no significant differences in the risk of unplanned reoperation (0.4%; -1.5-2.2) or unplanned readmission (0.2%; -1.2-1.5). CONCLUSIONS MIS repair of congenital anomalies is associated with improved perioperative outcomes when compared to open. Additional studies are needed to compare long-term functional and disease-specific outcomes. MINI-ABSTRACT In this propensity-weighted multi-institutional analysis of nine congenital anomalies, minimally invasive surgical repair was associated with improved 30-day outcomes when compared to open surgical repair. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Lindsay A Gil
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA
| | - Lindsey Asti
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA
| | - Jordan C Apfeld
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA
| | - Yuri V Sebastião
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Division of Global Women's Health, School of Medicine, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Katherine J Deans
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA.
| |
Collapse
|
6
|
Saberi RA, Gilna GP, Slavin BV, Cioci AC, Urrechaga EM, Parreco JP, Perez EA, Sola JE, Thorson CM. Outcomes for Ladd's procedure: Does approach matter? J Pediatr Surg 2022; 57:141-146. [PMID: 34657741 DOI: 10.1016/j.jpedsurg.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Laparoscopic Ladd's procedure has been proven safe and effective for the treatment of malrotation. However, the nationwide utilization and outcomes of elective Ladd's procedure are largely unknown. METHODS The Nationwide Readmissions Database from 2010 to 2014 was used to identify patients 0-18 years (excluding newborns) with malrotation who underwent elective Ladd's procedure. Demographics, hospital factors, and outcomes were compared by approach (laparoscopic vs. open) using standard statistical tests and propensity score (PS) matched analysis. Results were weighted for national estimates. RESULTS 1343 patients (44% male) underwent elective Ladd's procedure via laparoscopic (22%) or open (78%) approach. Laparoscopic approach was more common in large hospitals (26% vs. 16%), patients >13 years (30% vs. 20%), and those with higher income (29% vs. 16%), all p < 0.001. Following PS matching, compared to the laparoscopic approach, open Ladd's was associated with index hospital length of stay > 7 days (20% vs. 8%), more post-operative gastrointestinal dysfunction (12% vs. < 1%), and more nausea, vomiting, and/or diarrhea (16% vs. 6%), all p < 0.001. The overall readmission rates within 30 days and the year of index operation were 8% and 15%, respectively. In the matched cohort, those undergoing laparoscopic Ladd's were less likely to be readmitted than those with the open approach (7% vs. 16%, p < 0.001) and experienced less gastrointestinal issues on readmission (5% vs. 15%, p = 0.002). There were similar rates of post-operative small bowel obstruction (< 3% vs. < 3%, p = 0.840) and volvulus (0% vs. < 1%, p = 0.136). Redo Ladd's procedure was performed in less than 4% of readmissions and all occurred within 5 days of initial hospital discharge. CONCLUSION The majority of Ladd's procedures in the U.S. are being performed open, despite comparable outcomes following a laparoscopic approach. Readmission rates are similar with either approach, and the rate of redo Ladd's procedure is lower than previously reported. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Rebecca A Saberi
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Gareth P Gilna
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Blaire V Slavin
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alessia C Cioci
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eva M Urrechaga
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua P Parreco
- Division of Trauma and Surgical Critical Care, Memorial Regional Hospital, Hollywood, FL, USA
| | - Eduardo A Perez
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan E Sola
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad M Thorson
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
7
|
Zhang Z, Chen Y, Yan J. Laparoscopic Versus Open Ladd's Procedure for Intestinal Malrotation in Infants and Children: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2021; 32:204-212. [PMID: 34609912 DOI: 10.1089/lap.2021.0436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aim: To compare clinical outcomes in infants and children with intestinal malrotation who were treated by laparoscopic or open Ladd's. Methods: PubMed, EMBASE, and Cochrane library were searched for studies comparing laparoscopy with open Ladd's for intestinal volvulus through January 5, 2021. Search terms were confined to Title/Abstract: "Intestinal Volvulus" OR "Intestinal malrotation" AND "Laparoscopy" AND "Laparotomy." Randomized controlled trials (RCTs) and retrospective studies comparing laparoscopy with open Ladd's in neonates, infants, or children were included. Outcomes evaluated included operative time, time to full feeds, length of hospital stay, rate of conversion, reoperation, overall postoperative complications, postoperative adhesive small bowel obstruction, and postoperative volvulus. Pooled odds ratios (OR) were calculated for dichotomous variables; pooled mean differences (MDs) were measured for continuous variables. Results: Fourteen studies were included, comprising 444 patients who underwent laparoscopic approach and 1422 patients who underwent open procedure. Laparoscopy group had shorter operative time (MD = -14.44 minutes, 95% confidence interval [CI] = -20.79 to -8.09, P < .00001), hospital stay (MD = -4.57 days, 95% CI = -7.58 to -1.56, P = .003), and time to full feeds (MD = -3.00 days, 95% CI = -3.80 to -2.19, P < .00001). Laparoscopic Ladd's procedure had less overall postoperative complications (OR = 0.35, 95% CI = 0.19-0.65, P = .0009), less postoperative adhesive small bowl obstruction (OR = 0.37, 95% CI = 0.19-0.74, P = .005), and more postoperative volvulus (OR = 2.97, 95% CI = 1.23-7.13, P = .02). There was no difference in incidence of reoperation rate (OR = 2.04, 95% CI = 0.96-4.33, P = .06). Conclusion: Laparoscopic procedure is superior to open Ladd's in operative time, hospital stay, time to full feeds, overall postoperative complication, and postoperative adhesive small bowel obstruction. However, more RCTs with adequate follow-up are needed to overcome the limitations of our study.
Collapse
Affiliation(s)
- Zhiyi Zhang
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Jiayu Yan
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| |
Collapse
|
8
|
Outcomes of laparoscopic and open surgical treatment of intestinal malrotation in children. J Pediatr Surg 2020; 55:2777-2782. [PMID: 32972740 DOI: 10.1016/j.jpedsurg.2020.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 07/10/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The safety of the laparoscopic treatment of intestinal malrotation remains controversial. This study compared the outcomes of laparoscopic and open surgical treatment of intestinal malrotation. METHODS A multicentric retrospective study included pediatric cases of intestinal malrotation operated on between 2005 and 2016. RESULTS This study included 227 children with a median age of 17 days (0-17.2 years), including 161 with a midgut volvulus. Forty-six(20.3%) procedures were started by laparoscopy and 181(79.7%) by laparotomy. Laparoscopy was more frequent for elective surgery (45.9%) than for emergency procedures (10.8%, p < 0.001). Conversions were significantly more frequent during emergency procedures (66.7% vs 17.9%)(p = 0.001). Considering only 61 elective surgeries, the mean hospital stay was significantly shorter after laparoscopy (5.3 days +/-5.2 vs 10.1 days +/-13, p = 0.01), the overall complication rate was comparable (15.8% vs 21.7%, p = 0.7) but post-operative volvulus was significantly more frequent after laparoscopy (13% vs 0%, p = 0.04). Outcomes of the two approaches were not significantly different after 166 emergency procedures. CONCLUSION Laparoscopy can be performed by experienced team for the treatment of selected cases of intestinal malrotation. Conversion to open surgery should be done with a low threshold, as the rate of volvulus recurrence is concerning. LEVEL OF EVIDENCE Level III.
Collapse
|
9
|
Sloan K, Alzamrooni A, Stedman FE, Ron O, Hall NJ. Diagnostic laparoscopy to exclude malrotation following inconclusive upper gastrointestinal contrast study in infants. Pediatr Surg Int 2020; 36:1221-1225. [PMID: 32803428 DOI: 10.1007/s00383-020-04729-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE We report the use of diagnostic laparoscopy as an alternative to laparotomy in the investigation of infants with clinical features concerning for malrotation and inconclusive upper gastrointestinal contrast study. METHOD Case note review of all infants in whom laparoscopy was performed during 2016-2020 to investigate for possible malrotation. RESULTS Eight infants were identified. All presented with acute clinical features of malrotation (bilious vomit) without evidence of an alternate explanatory diagnosis. All underwent upper gastrointestinal contrast study, with three also undergoing abdominal ultrasound. The radiological examinations could not exclude malrotation and all proceeded to laparoscopy. At laparoscopy, the small intestine was run to exclude the presence of midgut volvulus. In six cases, normal rotation was confirmed and no abnormal pathology was found. Two proceeded to laparotomy and underwent correction of malrotation. All infants recovered without complication. CONCLUSION Laparoscopy is an excellent modality for further investigation of infants presenting acutely in whom intestinal malrotation cannot be formally excluded radiologically. The positive identification of the DJ flexure and cecum in correct anatomical sites, both fixed to the posterior abdominal wall, provides adequate reassurance of low risk of volvulus and avoids a full laparotomy. We recommend diagnostic laparoscopy in cases of inconclusive upper gastrointestinal contrast study.
Collapse
Affiliation(s)
- K Sloan
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK.
| | - A Alzamrooni
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - F E Stedman
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - O Ron
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK
| | - N J Hall
- Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK.,University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
10
|
Abstract
BACKGROUND Laparoscopic approach for malrotation has become more popular for neonates and in cases with volvulus, but its safety and efficacy remains controversial. This study reviewed laparoscopy outcomes in neonate/infant malrotation. METHODS Medline/PubMed and Lilacs databases were reviewed. Data from studies published in English/Spanish between 1995 and 2019 were collected. Results are presented as percentages and means/medians; logistic regression was used to study possible associations. RESULTS Nineteen papers offered 99 neonates/infants with median age and weight of 10.5 days and 3.5 kg, respectively. Ladd's procedure was performed in 95 (96%) patients and bands' division in 4 (4%); appendectomy was not included in 16 (16.2%) patients, and cecopexy was not performed in all cases. Volvulus was reported in 39 (39.4%) patients. There were 11 conversions (11.1%) and 10 recurrences of symptoms (10.1%) that required reintervention. An association was found between volvulus and recurrence (P = .05) and the need for conversion (P < .01). There were 10 (10.1%) minor complications and no mortality. The median follow-up was 10 months. DISCUSSION Laparoscopic approach to malrotation is feasible and safe in hemodynamically stable neonates/infants without intestinal necrosis and is associated with 11% conversion rate and 10% reinterventions. The presence of volvulus is associated with recurrence and conversion. Laparoscopic Ladd's procedure with appendectomy and without cecopexy is the commonly practiced approach that is associated with minor complications.
Collapse
Affiliation(s)
- Karina M da Costa
- 9762 Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK.,42487 Division of Pediatric Surgery, Department of Pediatrics, Regional University Hospital of Maringá, State University of Maringá, Maringá, Brazil
| | - Amulya K Saxena
- 9762 Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK
| |
Collapse
|
11
|
Pham HD, Okata Y, Vu HM, Xuan NT, Duc TT. Laparoscopic Ladd's procedure in neonates: A simple landmark detorsion technique. Pediatr Int 2020; 62:828-833. [PMID: 32048368 DOI: 10.1111/ped.14194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/28/2020] [Accepted: 02/10/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND The aim of this study was to assess the efficacy of our simple landmark technique for laparoscopic detorsion and the Ladd's procedure (lap-Ladd) for malrotation with midgut volvulus in neonates and to identify the risk factors for reoperation after the lap-Ladd. METHODS We conducted a retrospective chart review of 42 patients after lap-Ladd for malrotation between April 2017 and June 2019. Information regarding patient status and intraoperative and postoperative data were analyzed. RESULTS Thirty-one patients had volvulus (73.8 %), while 11 patients did not (26.2%). The median age and weight between the two groups at operation were 9 days (range, 3-28 days), 3.2 kg (range, 2-8 kg) and 6 days (range, 2-11), 2.9 kg (range, 2-3.8 kg), respectively. The operative time was significantly shorter in patients with volvulus compared to those without (60 vs 105 min, P = 0.002). Two cases were converted to open surgery because of ischemic changes of the total small intestine during surgery. Reoperation was required in two patients with volvulus (due to adhesive small bowel obstruction and recurrent volvulus). There was no significant predictive factor for reoperation after the lap-Ladd procedure. CONCLUSION Our simple landmark lap-Ladd procedure demonstrated feasibility and good short-term outcomes in neonates with malrotation, regardless of the presence or absence of volvulus.
Collapse
Affiliation(s)
- Hien Duy Pham
- Department of Pediatric Surgery, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Yuichi Okata
- Department of Pediatric Surgery, Vietnam National Children's Hospital, Hanoi, Vietnam.,Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hoan Manh Vu
- Department of Pediatric Surgery, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Nam Tran Xuan
- Department of Pediatric Surgery, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Tam Tran Duc
- Department of Pediatric Surgery, Vietnam National Children's Hospital, Hanoi, Vietnam
| |
Collapse
|
12
|
Svetanoff WJ, Sobrino JA, Sujka JA, St Peter SD, Fraser JD. Laparoscopic Ladd Procedure for the Management of Malrotation and Volvulus. J Laparoendosc Adv Surg Tech A 2020; 30:210-215. [PMID: 31895626 DOI: 10.1089/lap.2019.0602] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: While laparoscopic Ladd procedure is commonly performed in patients with asymptomatic malrotation, a paucity of data exists on children with volvulus or with low weight (≤3 kg). Our purpose was to evaluate the safety and efficacy of the laparoscopic Ladd procedure in these complex patient populations. Methods: A retrospective review of patients undergoing operation for malrotation from 2008 to 2018 was performed. Specific subgroup analysis was performed comparing outcomes after open and laparoscopic approaches in patients presenting with acute volvulus or in low-weight (<3 kg) patients. Results: Out of 110 patients, 38 (35%) presented with volvulus and 72 (65%) without volvulus. In patients with volvulus, 16 (42%) underwent laparoscopy and 22 (58%) had an open procedure. More patients in the open group had a preoperative diagnosis of volvulus (63.6% vs. 12.5%, P = .002). Operative time was longer in the laparoscopic group (87 vs. 61 minutes, P = .029), with 7 patients being converted to an open procedure (44%). Days to regular diet, hospital length of stay, and recurrent volvulus were similar between groups. In patients weighting <3 kg, 10 patients underwent laparoscopy and 10 patients had an open procedure. Demographics, operative time, postoperative outcomes, and complications were similar between groups. One person in the laparoscopic group was converted to open. Conclusion: Laparoscopic management of malrotation, even in the presence of volvulus and low patient weight, is safe and effective, with low rates of recurrent volvulus. If exposure is suboptimal, conversion to open in patients with volvulus should be considered.
Collapse
Affiliation(s)
| | - Justin A Sobrino
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Joseph A Sujka
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Jason D Fraser
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| |
Collapse
|
13
|
Abo Elyazeed AM, Shalaby MM, Awad MM, Effat AM, Abdella AE, Shehata SM. Idiopathic Hypertrophic Pyloric Stenosis with Complete Ladd's Band: A Rare Association. European J Pediatr Surg Rep 2019; 7:e66-e68. [PMID: 31763128 PMCID: PMC6874506 DOI: 10.1055/s-0039-1698400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 08/16/2019] [Indexed: 11/23/2022] Open
Abstract
A male infant aged 45 days presented with projectile nonbilious vomiting for 2 weeks. Ultrasound showed picture of idiopathic hypertrophic pyloric stenosis. Laparoscopic pyloromyotomy was done, but postoperative vomiting that was mainly nonbilious continued without improvement. After 4 days of persistent vomiting, laparoscopic exploration was done and complete pyloromyotomy was confirmed and malrotation with complete Ladd's band was found, then case converted to open laparotomy and Ladd's procedure was done. Postoperatively, vomiting stopped completely and baby began gradual feeding till reaching full feed. Despite that the presentation of concurrent Idiopathic Hypertrophic Pyloric Stenosis with malrotation is extremely rare; a formal laparoscopic abdominal exploration should be done as the first step before proceeding to pyloromyotomy.
Collapse
Affiliation(s)
- Ahmed M Abo Elyazeed
- Division of Surgery, Department of Pediatric Surgery, Tanat University Hospital, Tanta, Gharbia, Egypt
| | - Mohamed M Shalaby
- Division of Surgery, Department of Pediatric Surgery, Tanat University Hospital, Tanta, Gharbia, Egypt
| | - Mohamed M Awad
- Division of Surgery, Department of Pediatric Surgery, Tanat University Hospital, Tanta, Gharbia, Egypt
| | - AbdelMotaleb M Effat
- Division of Surgery, Department of Pediatric Surgery, Tanat University Hospital, Tanta, Gharbia, Egypt
| | - Ahmed E Abdella
- Division of Surgery, Department of Pediatric Surgery, Tanat University Hospital, Tanta, Gharbia, Egypt
| | - Sherif Mohamed Shehata
- Division of Surgery, Department of Pediatric Surgery, Tanat University Hospital, Tanta, Gharbia, Egypt
| |
Collapse
|
14
|
Arnaud AP, Suply E, Eaton S, Blackburn SC, Giuliani S, Curry JI, Cross KM, De Coppi P. Laparoscopic Ladd's procedure for malrotation in infants and children is still a controversial approach. J Pediatr Surg 2019; 54:1843-1847. [PMID: 30442460 DOI: 10.1016/j.jpedsurg.2018.09.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/27/2018] [Accepted: 09/30/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Open Ladd's procedure is the gold standard for the correction of intestinal malrotation and laparoscopic approach remains controversial. This study aimed to evaluate our experience in laparoscopic management of malrotation. METHODS Single center retrospective study including patients who underwent a laparoscopic assessment of intestinal malrotation with correction if appropriate between 2007 and 2017. RESULTS Sixty-five patients (median age 7 months) had a laparoscopic assessment with and without correction of malrotation. Forty-five (69%) were symptomatic, including 16 (25%) with a midgut volvulus. The procedure was completed laparoscopically in 55 (86%) patients in 110 min (30-190). Conversions happened more frequently at the beginning of the experience. With a follow-up of 12.5 months (8 days-5.3 years), morbidity rate was 15% and 4 (6%) patients underwent a redo surgery, all in the first 5 months after surgery, compared with 3/53 (6%) in a contemporaneous group undergoing open Ladd's. CONCLUSION This is the largest series reported so far of the laparoscopic management of malrotation. Laparoscopic Ladd's procedure is reliable but still exposes to open conversion which may be in part owing to a learning curve. A low conversion threshold is important in cases with volvulus. The redo rate is similar to that of the open procedure. LEVEL OF EVIDENCE Level III retrospective comparative treatment study.
Collapse
Affiliation(s)
- Alexis Pierre Arnaud
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, NHS Foundation Trust, London, UK.
| | - Etienne Suply
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, NHS Foundation Trust, London, UK.
| | - Simon Eaton
- Stem Cells and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, London, UK.
| | - Simon C Blackburn
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, NHS Foundation Trust, London, UK.
| | - Stefano Giuliani
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, NHS Foundation Trust, London, UK.
| | - Joe Igniatius Curry
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, NHS Foundation Trust, London, UK.
| | - Kate M Cross
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, NHS Foundation Trust, London, UK.
| | - Paolo De Coppi
- Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital, NHS Foundation Trust, London, UK; Stem Cells and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, London, UK.
| |
Collapse
|
15
|
Predictors of Bowel Resection During Nonelective Ladd Procedure for Pediatric Malrotation. J Surg Res 2019; 243:419-426. [PMID: 31279268 DOI: 10.1016/j.jss.2019.05.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 05/01/2019] [Accepted: 05/30/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The objective of this study was to identify risk factors for bowel resection in a modern cohort of patients undergoing nonelective Ladd procedures. MATERIALS AND METHODS Retrospective descriptive analysis of patients with Ladd procedure (CPT 44055) in the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2012-2015). Exclusion criteria were elective case, duodenal atresia, or other known congenital anomaly (except cardiac, structural central nervous system, or airway anomaly) and open wounds from prior surgery or drains. Independent variables included all preoperative variables within NSQIP-P. The primary outcome variable was bowel resection as a concurrent procedure. Multivariate analysis was performed by incorporating all independent variables into a stepwise forward logistic regression model to identify independent risk factors for bowel resection. RESULTS Of 267,289 patients in NSQIP-P, 1284 had a Ladd procedure. Of these, 292 were performed urgently or emergently in children with no known atresias, congenital anomalies, or open wounds. Twenty-nine (10%) had a bowel resection. On univariate analysis, bowel resection rates did not differ by age, weight, prematurity, ventilator dependence, asthma, chronic lung disease, tracheostomy, esophageal or gastrointestinal disease, hepatobiliary or pancreatic disease, cerebral palsy, central nervous system abnormality, neuromuscular disorder, intraventricular hemorrhage, steroid use, hematologic disorder, malignancy, sepsis, inotropic support, or CPR (P = nonsignificant). Higher rates of bowel resection were observed in patients with cardiac risk factors, white blood count (WBC) >15K, oxygen support, nutritional support, and developmental delay (P < 0.05). Only cardiac risk factors and WBC >15K were significant on multivariate analysis. CONCLUSIONS Bowel resections (10% in this cohort of nonelective Ladd procedures) were independently associated with cardiac risk factors and WBC >15K. LEVEL OF EVIDENCE III.
Collapse
|
16
|
Agrawal V, Tiwari A, Acharya H, Mishra R, Sharma D. Laparoscopic 'steering wheel' derotation technique for midgut volvulus in children with intestinal malrotation. J Minim Access Surg 2019; 15:219-223. [PMID: 29737312 PMCID: PMC6561056 DOI: 10.4103/jmas.jmas_24_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Since the first description by William Ladd, the Ladd's procedure has been the surgery of choice for the correction of malrotation. The laparoscopic Ladd's procedure is becoming popular with the advent of minimal access surgery and is described in the literature. Various techniques of the Ladd's procedure have been described but none of them describes the stepwise technique for derotation of volvulus which is the most difficult and confusing part of the surgery. We describe ‘steering wheel’ technique for easy derotation of volvulus associated with malrotation. Method: A total of 62 patients were diagnosed to have an intestinal malrotation between 2010 and 2017. All cases which had complete non-rotation with a midgut volvulus were reviewed. Out of these, 48 patients were operated with open technique and 14 patients were subjected to the laparoscopic correction. Technique: Using three-port technique, stepwise derotation of volvulus is done which simulates the rotation of steering of car at an acute turn and has been described in four simple steps. This technique also stresses the importance of the release of Ladd's band before derotation. Results: Of 62 patients diagnosed with malrotation, 14 (22.6%) patients underwent the laparoscopic Ladd's procedure. The mean age was 26 + 8 months, mean weight was 10 + 2 kg and included eight males (57%) and six females (43%). There was only one (7.14%) conversion to open technique, due to a huge dilatation of duodenum causing difficulty in dissection in a patient with malrotation without volvulus. The laparoscopic Ladd's procedure took an average time of 70 ± 15 min. Conclusion: The laparoscopic ‘steering wheel’ derotation technique is easy and provides a stepwise description of the laparoscopic derotation of volvulus associated with malrotation in children.
Collapse
Affiliation(s)
- Vikesh Agrawal
- Department of Surgery, Pediatric Surgery Division, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Abhishek Tiwari
- Department of Surgery, Pediatric Surgery Division, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Himanshu Acharya
- Department of Surgery, Pediatric Surgery Division, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Rajesh Mishra
- Department of Surgery, Pediatric Surgery Division, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Dhananjaya Sharma
- Department of Surgery, Pediatric Surgery Division, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| |
Collapse
|
17
|
Ismail M, Elgffar Helal AA. Laparoscopic diagnostic finding in atypical intestinal malrotation in children with equivocal imaging studies. Afr J Paediatr Surg 2018; 15:121-125. [PMID: 32769361 PMCID: PMC7646688 DOI: 10.4103/ajps.ajps_132_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Atypical presentation of intestinal malrotation provide a diagnostic and therapeutic dilemma for the surgeon to answer the question is it wisdom to operate or not? Upper gastrointestinal (UGI) contrast study is essential for diagnosis; however, 'soft' radiologic findings place the responsibility of excluding malrotation directly on the surgeon. Recently, minimally invasive surgical techniques would be able to accomplish the identical evaluation and treatment of this group of patients. PATIENTS AND METHODS A total of 40 patients (25 male, 15 female), age of 2-14 years, presented with symptoms of chronic abdominal pain, intermittent upper intestinal obstruction, recurrent bilious vomiting and failure to thrive. On clinical examination, none of the patients had signs of acute abdominal emergency. UGI contrast study was done and it was equivocal. All patients underwent laparoscopic evaluation. RESULTS A total of 36 patients (90%) were found on laparoscopy to have a discrepant finding of chronic intestinal malrotation. With narrow mesenteric base which put them at significant risk of midgut volvulus. Two patients (5%) were found to have chronic appendicitis with extensive adhesion at the right iliac fossa, one patient (2.5%) has annular pancreas and one patient has negative laparoscopic exploration. Laparoscopic findings of chronic intestinal malrotation includes, huge dilated stomach and the first part of duodenum, ectopic site of caecum central in the abdomen or under the liver, medial and low position of duodenojejunal junction, congested mesenteric veins with lymphatic oedema, generalised mesenteric lymphadenopathy, reversed relation of superior mesenteric artery and vein, right-sided small bowel. CONCLUSION Laparoscopic diagnostic finding permits direct evaluation and treatment of undocumented malrotation in children, with equivocal UGI contrast study. Furthermore, laparoscopy provides an excellent opportunity to assess the base of the mesentery. Those children with a narrow base should undergo laparoscopic Ladd procedure to avoid catastrophic midgut volvulus.
Collapse
Affiliation(s)
- Maged Ismail
- Pediatric Surgery Unit, Al-Azhar University Hospitals, Cairo, Egypt
| | | |
Collapse
|
18
|
Wall JK, Sinclair TJ, Kethman W, Williams C, Albanese C, Sylvester KG, Bruzoni M. Advanced minimal access surgery in infants weighing less than 3kg: A single center experience. J Pediatr Surg 2018; 53:503-507. [PMID: 28549685 DOI: 10.1016/j.jpedsurg.2017.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/03/2017] [Accepted: 05/07/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Minimal access surgery (MAS) has gained popularity in infants less than 5kg, however, significant challenges still arise in very low weight infants. STUDY DESIGN A retrospective chart review was performed to identify all infants weighing less than 3kg who underwent an advanced MAS or equivalent open procedure from 2009 to 2016. Advanced case types included Nissen fundoplication, duodenal atresia repair, Ladd procedure, congenital diaphragmatic hernia repair, esophageal atresia/tracheoesophageal fistula repair, diaphragmatic plication, and pyloric atresia repair. A comparative analysis was performed between the MAS and open cohorts. RESULTS A total of 45 advanced MAS cases and 17 open cases met the inclusion criteria. Gestational age and age at operation were similar between the cohorts, while infants who underwent open procedures had significantly lower weight at operation (p=0.003). There were no deaths within 30days related to surgery in either group. Only 3 MAS cases required unintended conversion to open. There were 2 (4.4%) postoperative complications related to surgery in the MAS cohort and 2 (11.8%) in the open cohort. CONCLUSION Advanced MAS may be performed in infants weighing less than 3kg with low mortality, acceptable rates of conversion, and similar rates of complications as open procedures. TYPE OF STUDY Prognosis study. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- James K Wall
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Tiffany J Sinclair
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - William Kethman
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Christina Williams
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Craig Albanese
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Karl G Sylvester
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Matias Bruzoni
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States.
| |
Collapse
|
19
|
Reddy AS, Shah RS, Kulkarni DR. Laparoscopic Ladd'S Procedure in Children: Challenges, Results, and Problems. J Indian Assoc Pediatr Surg 2018; 23:61-65. [PMID: 29681694 PMCID: PMC5898205 DOI: 10.4103/jiaps.jiaps_126_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Laparoscopic correction of malrotation in children is challenging. Authors review their experience with indications, results and problems of laparoscopic correction of malrotation. Materials and Methods: This is a retrospective study of 41 cases of children who were diagnosed as Intestinal malrotation on clinical and radiological evaluation. Results: Successful laparoscopic Ladd's procedure was accomplished in 35 cases. There were six conversions to open surgery. The mean hospital stay was 4 days (range 3-12days). Restoration of complete feed was achieved on an average of 3 days (range 2-4days). Post-operative recurrence of symptoms was seen in nine cases. Of which, five cases had incomplete correction, three cases had duodenal kinking due to adhesive intestinal obstruction and one had intra luminal duodenal obstruction. All patients underwent open surgery for recurrent symptoms. Conclusion: Laparoscopic Ladd's procedure is feasible in children with intestinal malrotation with or without associated volvulus. However, some of them need conversion to open surgery due to difficult local anatomy. For persistent symptoms, they may require redo surgery, which may be due to incomplete correction, adhesive obstruction or intraluminal obstruction.
Collapse
Affiliation(s)
- A Suyodhan Reddy
- Department of Pediatric Surgery, Grant Medical College and Sir J.J. Hospital, Mumbai, Maharashtra, India
| | - Rasik S Shah
- Department of Pediatric Surgery, Grant Medical College and Sir J.J. Hospital, Mumbai, Maharashtra, India.,Department of Pediatric Surgery, P. D. Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
| | - Dattaguru R Kulkarni
- Department of Pediatric Surgery, Grant Medical College and Sir J.J. Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
20
|
Abdominoplasty for Ladd’s procedure. ANNALS OF PEDIATRIC SURGERY 2017. [DOI: 10.1097/01.xps.0000508436.83738.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
21
|
Huntington JT, Lopez JJ, Mahida JB, Ambeba EJ, Asti L, Deans KJ, Minneci PC. Comparing laparoscopic versus open Ladd's procedure in pediatric patients. J Pediatr Surg 2017; 52:1128-1131. [PMID: 27856011 DOI: 10.1016/j.jpedsurg.2016.10.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/28/2016] [Accepted: 10/15/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND/PURPOSE The objective of this study was to perform a comparative analysis of laparoscopic versus open Ladd's procedure on 30-day postoperative outcomes. METHODS All elective Ladd's procedures performed on patients with intestinal malrotation in the 2013-2014 National Surgical Quality Improvement Program Pediatric were identified. A propensity score-matched analysis was used to account for baseline differences between groups, and generalized estimating equations (GEEs) were used to compare 30-day outcomes between open versus laparoscopic groups. RESULTS Fifty-eight (18.6%) patients underwent laparoscopic Ladd's while 253 (81.4%) underwent an open technique. After propensity score matching, 53 laparoscopic cases (38.1%) and 86 open cases (61.9%) were identified and compared for outcomes. Total length of stay was shorter for the laparoscopic group compared to the open group (6 vs. 4days, p<0.001). Postoperative length of stay was shorter for the laparoscopic group as well (5 vs. 4days, p<0.001). Postoperative complications occurred in 5 laparoscopic cases (9.4%) and in 18 open cases (20.9%), but did not meet statistical significance (p=0.08). One laparoscopic patient (1.9%) and 8 open patients (9.3%) required hospitalization beyond 30days, but this also did not meet significance (p=0.08). CONCLUSIONS In a matched analysis, laparoscopic Ladd's led to shorter hospital stays than open Ladd's in the initial 30-day postoperative period. Short-term benefits of laparoscopic Ladd's lend support for using additional resources to perform multi-institutional studies to compare differences in long-term outcomes between laparoscopic and open Ladd's. TYPE OF STUDY Therapeutic LEVEL OF EVIDENCE: III.
Collapse
Affiliation(s)
- Justin T Huntington
- Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Joseph J Lopez
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Justin B Mahida
- Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Erica J Ambeba
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Lindsey Asti
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Katherine J Deans
- Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Peter C Minneci
- Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
| |
Collapse
|
22
|
The surgical management of malrotation: A Canadian Association of Pediatric Surgeons survey. J Pediatr Surg 2017; 52:853-858. [PMID: 28189453 DOI: 10.1016/j.jpedsurg.2017.01.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/23/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE Some surgeries are now performed almost exclusively via a laparoscopic approach to enhance recovery and reduce postoperative complications. This survey explored institutional and individual physician practice patterns of the surgical management of malrotation. METHODS All 2015 Canadian Association of Pediatric Surgeons annual meeting attendees were invited to complete an anonymous prepiloted survey. Descriptive statistics were calculated. RESULTS The response rate was 35% (150 distributed, 52 returned). Most institutions (39.5%) saw on average 5-10 cases of malrotation per year. Most respondents (54.2%) indicated that the laparoscopic (LL) and open Ladd's (OL) procedures were equal surgical approaches for stable patients. Respondents were nearly equally divided (47.9% yes; 44.7% no) with respect to whether an LL procedure led to a higher risk of postoperative volvulus. Of those who answered yes, most indicated that an increased risk of postoperative volvulus was because of an inadequate widening of mesentery (45.8%), reduced "beneficial" postoperative adhesions (29.2%), or both (16.7%). 100% of respondents who perform an OL as their standard procedure indicated that there was a higher risk of postoperative volvulus with LL procedure. Only 1/8 who performed a LL as a standard approach routinely performed an appendectomy. CONCLUSION There remain polarized views on the best surgical approach to malrotation yet a persistent belief in the reduction in postoperative adhesions in leading to a postoperative volvulus with LL procedures. Collaboration to permit long-term follow-up of a large cohort may help develop guidelines for the operative management of malrotation. LEVEL OF EVIDENCE Level V.
Collapse
|
23
|
Putnam LR, Anderson KT, Tsao K, Kao LS, Lugo JA, Lally KP, Kawaguchi AL. The impact of cardiac risk factors on short-term outcomes for children undergoing a Ladd procedure. J Pediatr Surg 2017; 52:390-394. [PMID: 27894758 DOI: 10.1016/j.jpedsurg.2016.09.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to describe the outcomes of children with and without congenital heart disease who undergo a Ladd procedure. METHODS The 2012-2014 National Surgical Quality Improvement Program Pediatric (NSQIP-P) data were queried for patients undergoing a Ladd procedure. Utilizing NSQIP-P definitions, patients were categorized into four cardiac risk groups (none, minor, major, severe) based on severity of cardiac anomalies, previous cardiac procedure(s), and ongoing cardiac dysfunction. Ladd procedures were elective/non-elective. Outcomes included length of stay, adverse events, and mortality. RESULTS 878 patients underwent Ladd procedures. 633 (72%) patients had no cardiac risk factors and 84 (10%), 109 (12%), and 52 (6%) had minor, major, and severe cardiac risk factors, respectively. Children with congenital heart disease experienced increased morbidity and mortality and longer hospital stays (all p<0.05). Elective Ladd procedures were associated with similar morbidity but shorter length of stay and lower mortality than non-elective procedures. Older age at time of operation was associated with fewer adverse events. CONCLUSIONS Although overall mortality remains low, children with higher risk cardiac disease experience increased morbidity and mortality when undergoing a Ladd procedure. Older age at the time of the Ladd procedure was associated with improved outcomes in children.
Collapse
Affiliation(s)
- Luke R Putnam
- Center for Surgical Trials and Evidence-based Practice, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.248, Houston, TX 77030, USA; Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.258, Houston, TX 77030, USA; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, USA
| | - Kathryn T Anderson
- Center for Surgical Trials and Evidence-based Practice, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.248, Houston, TX 77030, USA; Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.258, Houston, TX 77030, USA; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, USA
| | - KuoJen Tsao
- Center for Surgical Trials and Evidence-based Practice, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.248, Houston, TX 77030, USA; Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.258, Houston, TX 77030, USA; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, USA
| | - Lillian S Kao
- Center for Surgical Trials and Evidence-based Practice, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.248, Houston, TX 77030, USA; Department of General Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.252, Houston, TX 77030, USA
| | - Jane A Lugo
- Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, USA
| | - Kevin P Lally
- Center for Surgical Trials and Evidence-based Practice, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.248, Houston, TX 77030, USA; Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.258, Houston, TX 77030, USA; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, USA
| | - Akemi L Kawaguchi
- Center for Surgical Trials and Evidence-based Practice, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.248, Houston, TX 77030, USA; Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.258, Houston, TX 77030, USA; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, USA.
| |
Collapse
|
24
|
Ferrero L, Ahmed YB, Philippe P, Reinberg O, Lacreuse I, Schneider A, Moog R, Gomes-Ferreira C, Becmeur F. Intestinal Malrotation and Volvulus in Neonates: Laparoscopy Versus Open Laparotomy. J Laparoendosc Adv Surg Tech A 2017; 27:318-321. [DOI: 10.1089/lap.2015.0544] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luisa Ferrero
- Department of Pediatric Surgery, University Hospitals, Strasbourg, France
| | - Yosra Ben Ahmed
- Department of Pediatric Surgery, Lapeyronie University Hospital, Montpellier, France
| | - Paul Philippe
- Department of Pediatric Surgery, University Hospital, Luxembourg, Luxembourg
| | - Olivier Reinberg
- Department of Pediatric Surgery, University Hospital, Lausanne, Switzerland
| | - Isabelle Lacreuse
- Department of Pediatric Surgery, University Hospitals, Strasbourg, France
| | - Anne Schneider
- Department of Pediatric Surgery, University Hospitals, Strasbourg, France
| | - Raphael Moog
- Department of Pediatric Surgery, University Hospitals, Strasbourg, France
| | | | - François Becmeur
- Department of Pediatric Surgery, University Hospitals, Strasbourg, France
| |
Collapse
|
25
|
Open versus laparoscopic approach for intestinal malrotation in infants and children: a systematic review and meta-analysis. Pediatr Surg Int 2016; 32:1157-1164. [PMID: 27709290 DOI: 10.1007/s00383-016-3974-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Although the principles of the Ladd's procedure for intestinal malrotation in children have remained unchanged since its first description, in the era of minimally invasive surgery it is controversial whether laparoscopy is advantageous over open surgery. The aim of our study was to determine whether the surgical approach for the treatment of malrotation had an impact on patient outcome. METHODS Using a defined strategy (PubMed, Cochrane, Embase and Web of Science MeSH headings), two investigators independently searched for studies comparing open versus laparoscopic Ladd's procedure in children. Case reports and opinion articles were excluded. Outcome measures included age at operation, time to full enteral feeding, length of hospital stay, and post-operative complications. Maneuvers were compared using Fisher's exact test and meta-analysis was conducted using RevMan 5.3. Data are expressed as mean ± SD. RESULTS Of 308 abstracts screened, 49 full-text articles were analyzed and nine (all retrospective) met our search criteria. Selected articles included 1003 patients, of whom 744 (74 %) underwent open surgery and 259 (26 %) laparoscopy. Patients who had open surgery were younger (0.9 ± 1.2 years) than those who underwent laparoscopy (2.6 ± 3 years; p < 0.0001). Laparoscopy was converted to open Ladd's in 25.3 % patients. Laparoscopy was associated with faster full enteral feeding (1.5 ± 0.3 days) in comparison to open surgery (4.6 ± 0.1 days, p < 0.0001). Length of hospital stay was shorter in the laparoscopic group (5.9 ± 4.3 days) than in the open group (11.2 ± 6.7 days; p < 0.0001). Open surgery was associated with higher overall post-operative complication rate (21 %) than laparoscopy (8 %; p < 0.0001). Although there was no difference in the prevalence of post-operative bowel obstruction (open, n = 10 %; laparoscopy, n = 0 % p = 0.07), post-operative volvulus was more frequent in the laparoscopy group (3.5 %) than in the open group (1.4 %, p = 0.04). CONCLUSION Comparative but non-randomized studies indicate that laparoscopic Ladd's procedure is not commonly performed in young children. Although one third of laparoscopic procedures is converted to open surgery, laparoscopy is associated with shorter time to full enteral feeds and length of hospital stay. However, laparoscopic Ladd's procedure seems to have higher incidence of post-operative volvulus. Prospective randomized studies with long follow-up are needed to confirm present outcome data and determine the safety and effectiveness of the laparoscopic approach.
Collapse
|
26
|
Abstract
Intestinal rotation abnormality (IRA) predisposes to lethal midgut volvulus. An understanding of intestinal development illustrates the process of normal intestinal rotation and fixation. An appreciation of the clinical presentation and consequences of missed IRA will enhance clinical suspicion and timely evaluation. Selecting the appropriate imaging modality to diagnose IRA requires an understanding of the benefits and limitations of each. The Ladd's procedure continues to be the appropriate surgical treatment for IRA with or without volvulus. Laparoscopy has emerged as an option for the diagnosis and treatment of IRA. Populations in which IRA is always associated, but a Ladd's procedure rarely required, include patients with congenital diaphragmatic hernia and abdominal wall defects. Prevalence of IRA is higher in children with congenital heart disease and heterotaxy syndrome; asymptomatic patients require multidisciplinary consideration of the risks and benefits of screening for IRA, whether a Ladd's procedure is required, and the timing thereof. [Pediatr Ann. 2016;45(7):e247-e250.].
Collapse
|
27
|
Kozlov YA, Novozhilov VA, Rasputin AA, Us GP, Kuznetsova NN, Pakelchuk A. [Endoscopic treatment of intestinal malrotation in newborns and infants]. Khirurgiia (Mosk) 2016:34-39. [PMID: 27239912 DOI: 10.17116/hirurgia2016434-39] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM To compare treatment of intestinal malrotation in newborns and infants using laparoscopy and laparotomy. MATERIAL AND METHODS For the period from January 2004 to December 2013 34 Ladd's procedures were performed. Children were divided into 2 groups by 17 patients: laparoscopic (group I) and open treatment (group II). RESULTS Both groups had similar demographic and other preoperative parameters. There were significant differences in duration of operation between both groups (61 vs. 70 minutes). Nutrition was initiated earlier after mini-invasive treatment (1.5 days vs. 3 days) and the time need for full enteral nutrition was also less (4.2 days vs. 6.9 days). Hospital-stay was shorter in group I (7.7 vs. 10.2 days). Number of early postoperative complications was similar in groups. Incidence of remote complications was higher in laparotomy group but the differences were not significant. CONCLUSION Our results showed that endoscopic correction of congenital anomalies of intestinal rotation provides better postoperative results than open surgery and can be widely used in young children.
Collapse
Affiliation(s)
- Yu A Kozlov
- City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk; Irkutsk State Medical Academy of Postgraduate Education, Irkutsk
| | - V A Novozhilov
- City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk; Irkutsk State Medical University, Irkutsk, Russia; Irkutsk State Medical Academy of Postgraduate Education, Irkutsk
| | - A A Rasputin
- City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk
| | - G P Us
- City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk
| | - N N Kuznetsova
- City Ivano-Matreninskaya Children's Clinical Hospital, Irkutsk
| | - A Pakelchuk
- Irkutsk State Medical University, Irkutsk, Russia
| |
Collapse
|
28
|
Healy JM, Olgun LF, Hittelman AB, Ozgediz D, Caty MG. Pediatric incidental appendectomy: a systematic review. Pediatr Surg Int 2016; 32:321-35. [PMID: 26590816 DOI: 10.1007/s00383-015-3839-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2015] [Indexed: 12/17/2022]
Abstract
Incidental appendectomy is the removal of the vermiform appendix accompanying another operation, without evidence of acute appendicitis. It is generally performed to eliminate the risk of future appendicitis. The risks and benefits of incidental appendectomy during various operations in children have been debated for over a century, but need to be revisited in light of innovations in medical practice, including minimally invasive surgery, improved imaging techniques, and use of the appendix as a tubular conduit for reconstruction. A detailed review was undertaken of the techniques, pathology, risks of appendectomy, utility of the appendix, and incidental appendectomy in the treatment of specific pediatric medical conditions. A comprehensive literature search was performed, and retrieved results were reviewed for relevance to the topic. The decision to perform a pediatric incidental appendectomy relies on informed consideration of the individual patient's co-morbid conditions, the indication for the initial operation, the future utility of the appendix, and the risk of future appendiceal pathology. The discussion includes a variety of situations and comorbid conditions that may influence a surgeon's decision to perform incidental appendectomy.
Collapse
Affiliation(s)
- James M Healy
- Department of Surgery, Yale University School of Medicine, 333 Cedar Street, TMP202, Box 208062, New Haven, CT, 06520, USA
| | - Lena F Olgun
- Department of Surgery, Yale University School of Medicine, 333 Cedar Street, TMP202, Box 208062, New Haven, CT, 06520, USA
| | - Adam B Hittelman
- Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Doruk Ozgediz
- Department of Surgery, Yale University School of Medicine, 333 Cedar Street, TMP202, Box 208062, New Haven, CT, 06520, USA
| | - Michael G Caty
- Department of Surgery, Yale University School of Medicine, 333 Cedar Street, TMP202, Box 208062, New Haven, CT, 06520, USA.
| |
Collapse
|
29
|
Abstract
The small intestine is a complex organ system that is vital to the life of the individual. There are a number of congenital anomalies that occur and present most commonly in infancy; however, some may not present until adulthood. Most congenital anomalies of the small intestine will present with obstructive symptoms while some may present with vomiting, abdominal pain, and/or gastrointestinal bleeding. Various radiologic procedures can aid in the diagnosis of these lesions that vary depending on the particular anomaly. Definitive therapy for these congenial anomalies is surgical, and in some cases, surgery needs to be performed urgently. The overall prognosis of congenital anomalies of the small intestine is very good and has improved with improved medical management and the advent of newer surgical modalities. The congenital anomalies of the small intestine reviewed in this article include malrotation, Meckel's diverticulum, duodenal web, duodenal atresia, jejunoileal atresia, and duplications.
Collapse
Affiliation(s)
- Grant Morris
- Department of Pediatrics, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - Alfred Kennedy
- Department of Pediatric Surgery, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - William Cochran
- Department of Pediatric Gastroenterology, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA, 17822, USA.
| |
Collapse
|
30
|
Graziano K, Islam S, Dasgupta R, Lopez ME, Austin M, Chen LE, Goldin A, Downard CD, Renaud E, Abdullah F. Asymptomatic malrotation: Diagnosis and surgical management: An American Pediatric Surgical Association outcomes and evidence based practice committee systematic review. J Pediatr Surg 2015. [PMID: 26205079 DOI: 10.1016/j.jpedsurg.2015.06.019] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Patients with malrotation, or an intestinal rotation abnormality (IRA), can experience serious adverse events. Increasingly, asymptomatic patients are being diagnosed with malrotation incidentally. Patients with symptomatic malrotation require surgery in an urgent or semiurgent manner to address their symptoms. The treatment of asymptomatic or incidentally discovered malrotation remains controversial. METHODS Data were compiled from a broad search of Medline, Cochrane, Embase and Web of Science from January 1980 through January 2013 for five questions regarding asymptomatic malrotation. RESULTS There is minimal evidence to support screening asymptomatic patients. Consideration may be given to operate on asymptomatic patients who are younger in age, while observation may be appropriate in the older patient. If reliably diagnosed, atypical malrotation with a broad-based mesentery and malposition of the duodenum can be observed. Regarding diagnostic imaging, the standard of care for diagnosis remains the upper gastrointestinal contrast study (UGI), ultrasound may be useful for screening. A laparoscopic approach is safe for diagnosis and treatment of rotational abnormalities. Laparoscopy can aid in determining whether a patient has true malrotation with a narrow mesenteric stalk, has nonrotation and minimal risk for volvulus, or has atypical anatomy with malposition of the duodenum. It is reasonable to delay Ladd procedures until after palliation on patients with severe congenital heart disease. Observation can be considered with extensive education for family and caregivers and close clinical follow-up. CONCLUSIONS There is a lack of quality data to guide the management of patients with asymptomatic malrotation. Multicenter and prospective data should be collected to better assess the risk profile for this complex group of patients. A multidisciplinary approach involving surgery, cardiology, critical care and the patient's caregivers can help guide a watchful waiting management plan in individual cases.
Collapse
Affiliation(s)
- Kathleen Graziano
- Division of Pediatric General Surgery, Phoenix Children's Hospital, Phoenix, AZ.
| | - Saleem Islam
- Division of Pediatric Surgery, University of Florida, Gainesville, FL
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, OH
| | - Monica E Lopez
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Mary Austin
- Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center; Department of Pediatric Surgery, University of Texas Medical School, Houston, TX
| | - Li Ern Chen
- Department of Surgery, Baylor University Medical Center, Dallas, TX
| | - Adam Goldin
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital; Department of Surgery, University of Washington, Seattle, WA
| | - Cynthia D Downard
- Division of Pediatric Surgery, Hiram C. Polk, Jr, MD; Department of Surgery, University of Louisville, Louisville, KY
| | - Elizabeth Renaud
- Division of Pediatric Surgery, Department of Surgery, Albany Medical Center, Albany, NY
| | - Fizan Abdullah
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
31
|
Laparoscopic diagnostic findings in atypical intestinal malrotation in children with equivocal imaging studies. ANNALS OF PEDIATRIC SURGERY 2015. [DOI: 10.1097/01.xps.0000469157.12636.6f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
32
|
Miyano G, Fukuzawa H, Morita K, Kaneshiro M, Miyake H, Nouso H, Yamoto M, Fukumoto K, Urushihara N. Laparoscopic Repair of Malrotation: What Are the Indications in Neonates and Children? J Laparoendosc Adv Surg Tech A 2015; 25:155-8. [DOI: 10.1089/lap.2014.0236] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Go Miyano
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hiroaki Fukuzawa
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Keiichi Morita
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masakatsu Kaneshiro
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hiromu Miyake
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hiroshi Nouso
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masaya Yamoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Koji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| |
Collapse
|
33
|
Robotic-assisted laparoscopic Ladd procedure for an adult with malrotation: case report and review. J Robot Surg 2014. [DOI: 10.1007/s11701-014-0467-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
34
|
Laparoscopic versus open Ladd's procedure for intestinal malrotation in adults. Surg Endosc 2014; 29:1598-604. [PMID: 25294535 DOI: 10.1007/s00464-014-3849-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/15/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Intestinal malrotation results from errors in fetal intestinal rotation and fixation. While most patients are diagnosed in childhood, some present as adults. Laparoscopic Ladd's procedure is an accepted alternative to laparotomy in children but has not been well-studied in adults. This study was designed to investigate outcomes for adults undergoing laparoscopic Ladd's repair for malrotation. METHODS We performed a single-institution retrospective chart review over 11 years. Data collected included patient age, details of pre-operative work-up and diagnosis, surgical management, complications, rates of re-operation, and symptom resolution. Patients were evaluated on an intent-to-treat basis based on their planned operative approach. Categorical data were analyzed using Fisher's exact test. Continuous data were analyzed using Student's t test. RESULTS Twenty-two patients were identified (age range 18-63). Fifteen were diagnosed pre-operatively; of the remaining seven patients, four received an intra-operative malrotation diagnosis during elective surgery for another problem. Most had some type of pre-operative imaging, with computed tomography being the most common (77.3 %). Comparing patients on an intent-to-treat basis, the two groups were similar with respect to age, operative time, and estimated blood loss. Six patients underwent successful laparoscopic repair; three began laparoscopically but were converted to laparotomy. There was a statistically significant difference in hospital length of stay (LOS) (5.0 ± 2.5 days vs 11.6 ± 8.1 days, p = 0.0148) favoring the laparoscopic approach. Three patients required re-operation: two underwent side-to-side duodeno-duodenostomy and one underwent a re-do Ladd's procedure. Ultimately, three (two laparoscopic, one open) had persistent symptoms of bloating (n = 2), constipation (n = 2), and/or pain (n = 1). CONCLUSION Laparoscopic repair appears to be safe and effective in adults. While a small sample size limits the power of this study, we found a statistically significant decrease in LOS and a trend toward decreased postoperative nasogastric decompression. There were no significant differences in complication rates, re-operation, or persistence of symptoms between groups.
Collapse
|
35
|
Lacher M, Kuebler JF, Dingemann J, Ure BM. Minimal invasive surgery in the newborn: current status and evidence. Semin Pediatr Surg 2014; 23:249-56. [PMID: 25459008 DOI: 10.1053/j.sempedsurg.2014.09.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The evolution of minimally invasive surgery (MIS) in the newborn has been delayed due to the limited working space and the unique physiology. With the development of smaller instruments and advanced surgical skills, many of the initial obstacles have been overcome. MIS is currently used in specialized centers around the world with excellent feasibility. Obvious advantages include better cosmesis, less trauma, and better postoperative musculoskeletal function, in particular after thoracic procedures. However, the aim of academic studies has shifted from proving feasibility to a critical evaluation of outcome. Prospective randomized trials and high-level evidence for the benefit of endoscopic surgery are still scarce. Questions to be answered in the upcoming years will therefore include both advantages and potential disadvantages of MIS, especially in neonates. This review summarizes recent developments of MIS in neonates and the evidence for its use.
Collapse
Affiliation(s)
- Martin Lacher
- Center of Pediatric Surgery, Hannover Medical School, Carl Neuberg St. 1, Hannover 30625, Germany.
| | - Joachim F Kuebler
- Center of Pediatric Surgery, Hannover Medical School, Carl Neuberg St. 1, Hannover 30625, Germany
| | - Jens Dingemann
- Center of Pediatric Surgery, Hannover Medical School, Carl Neuberg St. 1, Hannover 30625, Germany
| | - Benno M Ure
- Center of Pediatric Surgery, Hannover Medical School, Carl Neuberg St. 1, Hannover 30625, Germany
| |
Collapse
|
36
|
Sykes JA, Bailey K, Phatak T, Bhattacharyya N, Kalyanaraman M. Visual diagnosis: a 16-year-old female with menstrual cramps and a history of anorexia. Pediatr Rev 2013; 34:e1-4. [PMID: 23281364 DOI: 10.1542/pir.34-1-e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Joseph A Sykes
- Division of Pediatric Critical Care, Children’s Hospital of New Jersey, Newark Beth Israel Medical Center, Newark, NJ, USA
| | | | | | | | | |
Collapse
|
37
|
|
38
|
|
39
|
Hsiao M, Langer JC. Surgery for suspected rotation abnormality: selection of open vs laparoscopic surgery using a rational approach. J Pediatr Surg 2012; 47:904-10. [PMID: 22595570 DOI: 10.1016/j.jpedsurg.2012.01.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 01/26/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Laparoscopy is increasingly used for children with suspected rotation abnormalities. However, indications for open and laparoscopic approaches are not well defined. We reviewed our experience with both open and laparoscopic approaches to develop a rational approach to these patients. METHODS Charts of all children undergoing surgery for a suspected rotation abnormality for 10 years were retrospectively reviewed. RESULTS There were 173 patients. Of 73 neonates presenting with suspected volvulus, 71 underwent initial laparotomy and 2 were converted from initial laparoscopy. Eighty percent underwent Ladd procedure, 64% had volvulus, and 2 died of midgut volvulus. Of 18 neonates presenting without suspected volvulus, 14 underwent initial laparotomy and 4 had a laparoscopic approach with 1 conversion to laparotomy. Seventy-eight percent underwent Ladd procedure, and 22% had volvulus. Of the 82 older patients, 37 underwent laparotomy and 45 had initial laparoscopy, 8 of which were converted. Sixty-seven percent underwent Ladd procedure, and 28% had volvulus. Postoperative complication rate, median time to full diet, and median hospital stay were comparable with those previously reported in the literature. CONCLUSION Based on our results, we advocate open surgery for neonates with suspected volvulus. Laparoscopy represents an excellent alternative for older children and for neonates presenting without suspected volvulus.
Collapse
Affiliation(s)
- Marvin Hsiao
- Division of General and Thoracic Surgery, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|
40
|
Hill S, Koontz CS, Langness SM, Wulkan ML. Laparoscopic Versus Open Repair of Congenital Duodenal Obstruction in Infants. J Laparoendosc Adv Surg Tech A 2011; 21:961-3. [DOI: 10.1089/lap.2011.0069] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sarah Hill
- Division of Pediatric Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Curt S. Koontz
- Division of Pediatric Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Simone M. Langness
- Division of Pediatric Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Mark L. Wulkan
- Division of Pediatric Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| |
Collapse
|
41
|
Value of laparoscopy in children with a suspected rotation abnormality on imaging. J Pediatr Surg 2011; 46:1347-52. [PMID: 21763833 DOI: 10.1016/j.jpedsurg.2010.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 12/08/2010] [Accepted: 12/10/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although imaging is usually used for the diagnosis of rotation abnormalities, significant false-positive and false-negative rates have been reported. We studied the utility of laparoscopy in the management of children with a suspected rotation abnormality on imaging. METHODS The charts of all children undergoing laparoscopy for a suspected intestinal rotation abnormality from January 2000 to August 2009 were retrospectively reviewed. RESULTS There were 51 patients. Preoperative diagnosis based on upper gastrointestinal contrast study with or without contrast enema or ultrasound was malrotation without volvulus in 47%, malrotation with volvulus in 10%, and nonrotation in 6%; the other 37% had equivocal or inconclusive imaging studies. Of the patients who had a "definitive" preoperative diagnosis, 41% had a discrepant finding at laparoscopy. For those with inconclusive imaging studies, 32% were found on laparoscopy to have a narrow mesenteric base, which put them at significant risk of midgut volvulus. CONCLUSION Imaging studies may be inaccurate in differentiating malrotation from nonrotation or normal rotation. Laparoscopy provides an excellent opportunity to assess the base of the mesentery. Those children without a narrow-based mesentery can undergo laparoscopy alone, and those with malrotation should undergo either laparoscopic or open Ladd procedure.
Collapse
|
42
|
Abstract
The advent of minimally invasive surgical techniques in the neonate has been delayed due to the limited working space and the unique physiology of the newborn. In the last decade, with the introduction of new instruments and techniques, many of the initial problems have been solved making minimally invasive surgery feasible for a variety of indications in the neonate and a favored approach in specialized centers around the world. Although an increasing number of reports document the feasibility of this exciting technique, data demonstrating its benefit compared to conventional surgery is limited. This review focuses on recent developments in minimally invasive surgery in neonates and the evidence for its use.
Collapse
|
43
|
Nasir AA, Abdur-Rahman LO, Adeniran JO. Outcomes of surgical treatment of malrotation in children. Afr J Paediatr Surg 2011; 8:8-11. [PMID: 21478578 DOI: 10.4103/0189-6725.78660] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Abnormalities of rotation and fixation of the intestines are of intense interest to the pediatric surgeon, as they are frequently associated with volvulus which has catastrophic consequences when diagnosis is delayed or not even considered. This study evaluates the outcomes of surgical management of intestinal malrotation (IM) in children. MATERIALS AND METHODS The medical records of all patients with symptomatic malrotation, who underwent surgery between January 2000 and September 2009, were reviewed. Patients' characteristics, management, complications, and survival were evaluated. RESULTS Nine patients (eight boys and a girl) underwent surgery for malrotation at a median age of 15 days. Eight presented with acute symptoms and one with chronic symptoms. All the patients had symptoms of intermittent or complete upper intestinal obstruction, and malrotation was documented by an upper gastrointestinal contrast study in two of them. Volvulus was found at the time of surgery in seven patients, five of whom were neonates. One patient also had associated mesentery cyst. Seven patients were treated by Ladd's operation. One patient with massive bowel gangrene due to volvulus had right hemicolectomy. There was one perioperative death from anastomostic leak. Median length of stay was 9 days. Postoperative bowel obstruction was seen in two patients (one died), resulting in an overall mortality of 22.2%. CONCLUSIONS Bowel gangrene from volvulus contributes to mortality, and small bowel adhesive intestinal obstruction is a cause of morbidity and mortality following surgery for IM. Neonates with bilious vomiting should raise the suspicion of malrotation until proven otherwise and given prompt intervention. There is a need for high index of suspicion in babies with bilious vomiting especially when recurrent to prevent devastating complications when present.
Collapse
Affiliation(s)
- A A Nasir
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
| | | | | |
Collapse
|
44
|
Abstract
Minimally invasive surgery (MIS) has significantly improved the field of surgery, with benefits including shorter operating time, improved recovery time, minimizing stress and pain due to smaller incisions, and even improving mortality. MIS procedures, including their indications, impact, limitations, and possible future evolution in neonates and infants, are discussed in this article.
Collapse
Affiliation(s)
- Tiffany Lin
- DeBakey Department of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | | |
Collapse
|
45
|
|
46
|
Stanfill AB, Pearl RH, Kalvakuri K, Wallace LJ, Vegunta RK. Laparoscopic Ladd's procedure: treatment of choice for midgut malrotation in infants and children. J Laparoendosc Adv Surg Tech A 2010; 20:369-72. [PMID: 20218938 DOI: 10.1089/lap.2009.0118] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Rotational anomalies of the midgut encompass a broad spectrum of incomplete rotational events with malfixation of the intestines during fetal development. Ladd's procedure, as a correction of these anomalies, has traditionally been performed by laparotomy. In our institution, the laparoscopic Ladd's (LL) procedure was introduced in May 2004 and soon became the standard approach. MATERIALS AND METHODS A retrospective analysis of all Ladd's procedures in children in our institution between September 1998 and June 2008 was performed. Outcomes between the open (OL) and LL procedures were compared. RESULTS A total of 156 children underwent Ladd's procedure during the study period. There were 120 open and 36 laparoscopic procedures. Overall, 75% of patients in each group were symptomatic, most commonly with emesis and pain. Duration of surgery was similar in both groups. Time to starting feeds, and amount of time to attain full feeding, was significantly less in the LL group. Postoperative length of stay was significantly less in the patients having LL. Conversion rate to OL from LL was 8.3%. CONCLUSIONS LL can be performed safely in selected patients with no increase in complications. Short-term results are superior to OL and can be achieved without any increase in operative duration.
Collapse
Affiliation(s)
- Amy B Stanfill
- Department of Pediatric Surgery, University of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, Peoria, IL 61603, USA.
| | | | | | | | | |
Collapse
|
47
|
Hagendoorn J, Vieira-Travassos D, van der Zee D. Laparoscopic treatment of intestinal malrotation in neonates and infants: retrospective study. Surg Endosc 2010; 25:217-20. [PMID: 20559662 PMCID: PMC3003780 DOI: 10.1007/s00464-010-1162-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 05/20/2010] [Indexed: 11/25/2022]
Abstract
Background Intestinal malrotation in neonates or infants may require urgent surgical treatment, especially when volvulus and vascular compromise of the midgut are suspected. Successful laparoscopic management of malrotation has been described in a number of case reports. It remains unclear, however, whether laparoscopy for the treatment of malrotation has a success rate equal to that of open surgery and what relative risks exist in terms of conversion and redo surgery in larger numbers of patients. This report describes a retrospective analysis of the clinical outcome for 45 children who underwent laparoscopic treatment of intestinal malrotation at the authors’ institution. Methods The 45 patients in this series, ages several days to 13 years, underwent a diagnostic laparoscopy for suspected intestinal malrotation. For 37 patients, malrotation with or without volvulus was diagnosed. All these patients underwent laparoscopic derotation and Ladd’s procedure. Results Successful laparoscopic treatment of intestinal malrotation could be performed in 75% of the cases (n = 28), and conversion to an open procedure was necessary in 25% of the cases (n = 9). The median hospital stay was 11 days (range, 2–60 days). Postoperative clinical relapse due to recurrence of malrotation, volvulus, or both occurred for 19% of the laparoscopically treated patients (n = 7). These patients underwent laparoscopic (n = 1) or open (n = 6) redo surgery. Conclusion Diagnostic laparoscopy is the procedure of choice when intestinal malrotation is suspected. If present, malrotation can be treated adequately with laparoscopic surgery in the majority of cases. Nevertheless, to prevent recurrence of malrotation or volvulus, a low threshold for conversion to an open procedure is mandated.
Collapse
Affiliation(s)
- Jeroen Hagendoorn
- Department of Pediatric Surgery, Wilhelmina Children’s Hospital/University Medical Center, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
| | - Daisy Vieira-Travassos
- Department of Pediatric Surgery, Wilhelmina Children’s Hospital/University Medical Center, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
| | - David van der Zee
- Department of Pediatric Surgery, Wilhelmina Children’s Hospital/University Medical Center, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
| |
Collapse
|
48
|
Zarroug AE, Srinivasan SK, Wulkan ML. Incidental chylous fluid during hernia repair may be a harbinger of malrotation. J Pediatr Surg 2010; 45:E17-8. [PMID: 20105567 DOI: 10.1016/j.jpedsurg.2009.10.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 10/09/2009] [Accepted: 10/20/2009] [Indexed: 10/20/2022]
Abstract
A previously asymptomatic 12-week-old male infant was found to have chylous ascites within his peritoneal hernia sacs during elective open bilateral inguinal hernia repair. Both repairs were completed, and an immediate postoperative upper gastrointestinal contrast study confirmed the presence of malrotation with associated volvulus. The patient underwent a Ladd's procedure and appendectomy. The postoperative course was uneventful. The finding of chylous ascites during hernia repair mandates investigation for possible malrotation.
Collapse
Affiliation(s)
- Abdalla E Zarroug
- Department of Surgery, Division of Pediatric Surgery, Mayo Clinic, Rochester, MN 55905, USA.
| | | | | |
Collapse
|
49
|
Fraser JD, Aguayo P, Sharp SW, Ostlie DJ, St. Peter SD. The Role of Laparoscopy in the Management of Malrotation. J Surg Res 2009; 156:80-2. [DOI: 10.1016/j.jss.2009.03.063] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 02/18/2009] [Accepted: 03/22/2009] [Indexed: 12/01/2022]
|
50
|
Abstract
Infants with intestinal malrotation present with bilious emesis and the diagnosis is generally obtained by an upper gastrointestinal barium study. Malrotation is suspected if the ligament of Treitz is not positioned to the left of the vertebral body. Three patients were admitted to our department from March 2006 to May 2007, aged three weeks, one month and eight months, weighing 3,3.200 and 8 kg respectively to whom laparoscopic Ladd's procedure was done successfully.
Collapse
Affiliation(s)
- Mohammed A Youssef
- Department of Paediatric Surgery, Alexandria Hospital for Sick Children, Health Insurance Authority, Alexandria, Egypt
| |
Collapse
|