Laparoscopic Ladd's Procedure: Treatment of Choice for Midgut Malrotation in Infants and Children

Abstract

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.

Surgery for suspected rotation abnormality: selection of open vs laparoscopic surgery using a rational approach

“…The median time to full diet and the median length of hospital stay in our series were comparable with those reported in the literature [5,6,10,11]. The neonatal group with suspected volvulus had the highest postoperative inhospital complication rate of 32%, one third of which consisted of bacteremia and sepsis.…”

“…With this conservative approach and despite the fact that 43% of our patients had volvulus, we had a low overall mortality rate (4%), which is comparable with literature values of 0 to 24% [10,11,21]. When considering only deaths caused by midgut volvulus, the mortality rate in our series was 1% (2/173 patients).…”

“…These 2 deaths were both approached with initial laparotomy and were both in group A, in which 64% of the neonates with suspected volvulus did indeed have volvulus intraoperatively. The 2 most recent large series with 154 and 284 patients who underwent open or laparoscopic Ladd procedure reported no deaths [10,11]. However, these 2 series included only patients who had undergone a Ladd procedure, had proportionally fewer patients with volvulus (15%) [10], and involved patients who were older than those in our series (median age, 3 months to 6 years) [10,11].…”

“…There have been several studies supporting the safety and efficacy of laparoscopic Ladd procedure [3][4][5][6][7][8]. Several series comparing laparoscopic to open Ladd procedure reported less postoperative pain, faster time to full diet, and shorter length of hospitalization [5,6,[9][10][11]. Despite this growing literature, the indications for the open or laparoscopic approaches have not yet been well defined.…”

An unusual cause of duodenal obstruction in adults

“…As most symptoms associated with midgut malrotation occur in childhood, surgical intervention in adults is rarely studied, yet the Ladd procedure has a favourable long-term complication and recurrence rate in children [21]. A laparoscopic technique has a comparable safety and complication profile as compared to open surgery [22], but less suitable in case of volvulus and commonly performed in malrotation-associated duodenal obstruction [6]. In absence of intestinal ischaemia, detorsion might be an alternative treatment option; however, there is a risk of recurrence.…”