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Takimoto A, Amano H, Sumida W, Shirota C, Yokota K, Makita S, Okamoto M, Ogata S, Takada S, Nakagawa Y, Kato D, Goda Y, Hinoki A, Uchida H. Laparoscopic Duodenal-Caudal Detachment Method: Early Experience of a Novel Technique for Malrotation with Volvulus in Neonates. J Laparoendosc Adv Surg Tech A 2023; 33:220-225. [PMID: 36383112 DOI: 10.1089/lap.2022.0390] [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: 11/17/2022] Open
Abstract
Purpose: A laparoscopic approach for malrotation is feasible and safe in hemodynamically stable neonates without intestinal necrosis; however, volvulus is associated with recurrence and conversion. We developed a novel approach using a laparoscopic duodenal-caudal detachment method to perform the Ladd procedure for neonates with volvulus under the limited view of laparoscopy. This study presents the results, effectiveness, and details of the method. Materials and Methods: In the laparoscopic duodenal-caudal detachment method, we first detached the adhesions around the duodenum, including the Ladd's band. After the adhesions were completely removed, the duodenum was freely drawn caudally, leading to the release of torsion. We retrospectively reviewed the medical records of patients who underwent surgery for malrotation of the volvulus at 30 days of age between January 2014 and September 2021. Results: Seven neonates underwent the laparoscopic duodenal-caudal detachment method and 13 underwent the open Ladd procedure. The new technique was performed in all 7 patients, and there were no conversions or recurrences. The operation time was significantly longer in the laparoscopic procedure group (55 minutes versus 111 minutes; P < .01). Conclusions: Our detorsion method, involving an initial incision of the Ladd's band, is safe and effective for neonates and may lead to an improvement in the conversion rates.
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Affiliation(s)
- Aitaro Takimoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Hizuru Amano
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Kazuki Yokota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Masamune Okamoto
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Seiya Ogata
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Shunya Takada
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Youichi Nakagawa
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Daiki Kato
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Yosuke Goda
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, , Showa, Nagoya, Japan
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Xie W, Li Z, Wang Q, Wang L, Pan Y, Lu C. Laparoscopic vs open Ladd's procedure for malrotation in neonates and infants: a propensity score matching analysis. BMC Surg 2022; 22:25. [PMID: 35081938 PMCID: PMC8793198 DOI: 10.1186/s12893-022-01487-1] [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: 03/30/2021] [Accepted: 01/18/2022] [Indexed: 08/30/2023] Open
Abstract
Background Laparoscopic Ladd’s procedure for malrotation in children is still a controversial approach. Although some retrospective studies have compared the outcomes of the two types of procedure with inconsistency outcomes. Currently, there are few large-scale studies on laparoscopic treatment in malrotation with neonates and infants. We did a study based on propensity score matching to compare the effects of the two kinds of approach in neonates and infants. To investigate the therapeutic effect of laparoscopy and open Ladd’s procedure by the propensity score-matching (PSM) to enhance the validity of the comparison. Methods A total series of 143 cases of intestinal malrotation without intestinal necrosis was included in the study during the 8 years from January 2012 to January 2020, including 68 cases of open Ladd’s procedure and 75 cases of laparoscopic Ladd’s procedure including five cases of transfer laparotomy. By a propensity score 1:1 matching, 62 patients were stratified for each group. Results and conclusion There was no significant difference in volvulus degree, weight and gender between the two groups (p > 0.05). Laparoscopic surgery took more time than open surgery (105.9 min vs 70.6 min, p < 0.05), but it had less hospital stay (12.4 days vs 14.6 days, p < 0.05) or less incision infection (0 vs 6, p < 0.05). There was no significant difference between the two groups at the time of first defecation, blood loss, time of full feeding and reoperation (p > 0.05). The cosmetic effect of laparoscopic surgery is better than that of open surgery. Laparoscopic Ladd’s procedure is a safe approach. It can reduce the length of hospital stay and incision infection, but the operation time was extended, the other complications are similar compared with open procedure for intestinal malrotation in neonates and infants.
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Affiliation(s)
- Weike Xie
- Department of Neonatal Surgery, Xi'an Children Hospital, 69 Xiyuyuanxiang, Xi'an, 710003, Shaanxi, China
| | - Zhongwen Li
- Department of Neonatal Surgery, Xi'an Children Hospital, 69 Xiyuyuanxiang, Xi'an, 710003, Shaanxi, China
| | - Qi Wang
- Department of Neonatal Surgery, Xi'an Children Hospital, 69 Xiyuyuanxiang, Xi'an, 710003, Shaanxi, China
| | - Lei Wang
- Department of Neonatal Surgery, Xi'an Children Hospital, 69 Xiyuyuanxiang, Xi'an, 710003, Shaanxi, China
| | - Yongkang Pan
- Department of Neonatal Surgery, Xi'an Children Hospital, 69 Xiyuyuanxiang, Xi'an, 710003, Shaanxi, China
| | - Chaoxiang Lu
- Department of Neonatal Surgery, Xi'an Children Hospital, 69 Xiyuyuanxiang, Xi'an, 710003, Shaanxi, China.
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