Laparoscopic Ladd's procedure for malrotation in infants and children is still a controversial approach

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 centre 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 minutes (30-190). Conversions happened more frequently at the beginning of the experience. With a follow-up of 12.5 months (8 days-5.3years), 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 due 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.

Recurrent midgut volvulus in an adult patient — The case for pexy? A case report and review of the literature

“…Recurrence of midgut volvulus after a childhood Ladd’s procedure is rare, reported to be between 2% and 7% [12,13,16].…”

“…The best available evidence among children places the recurrence rate at 1.4%–3.5% (for open and laparoscopic Ladd procedure, respectively) [12,13,16,[25], [26], [27], [28]]. The rate of recurrence among patients who underwent Ladd’s procedure in adulthood in some of the series is much higher than that reported in children with a recurrence rate as high as 16% [17] and 18% [10] in some series.…”

“…Recurrence of midgut volvulus after a Ladd procedure during childhood is a rare event [12,13]. Given the rarity of adult presentations of midgut volvulus, information on prognosis and reports of recurrence after Ladd procedure in adulthood are even more scarce.…”

Patch repair of congenital diaphragmatic hernia is not at risk of poor outcomes

“…The risk of volvulus was usually assessed by an upper gastro-intestinal tract contrast study and an additional Ladd's procedure was performed if indicated. The operation was performed laparoscopically in most cases and results were reported in a recently published study [16].…”

Laparoscopic Ladd Procedure for Malrotation in Newborns and Infants

“…So far, the supporting evidence suggests that laparoscopic Ladd's procedure should be reserved for selected cases: hemodynamically stable, without perforation, or evidence of ischemic distress. 20,34 There is controversy regarding the role of postoperative adhesion formation in long-term outcomes of malrotation surgery. 10,13,14 It has been suggested that laparoscopic Ladd's procedure, predisposing to less adhesion development, would not decrease the risk of volvulus as much as the open procedure.…”