Let sleeping dogs lie: To leave the appendix at the time of a Ladd procedure

Davidson, Joseph; Eaton, Simon; Coppi, Paolo De

doi:10.1016/j.jpedsurg.2017.09.003

Cited by 6 publications

(8 citation statements)

References 28 publications

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“…Indications for surgery were: suspicion of volvulus (n=14), symptomatic malrotation without suspicion of volvulus (31) and prophylactic (20). Predominant presenting symptoms ( Figure 1) were bilious vomiting (19), non-bilious vomiting (8), gastro-oesophageal reflux (9), abdominal pain (7) and failure to thrive (2). Four patients presenting with symptoms had a previously diagnosed situs inversus.…”

Section: Surgical Data (Table 2)mentioning

confidence: 99%

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

Arnaud

Suply

Eaton

et al. 2019

Journal of Pediatric Surgery

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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.

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Section: Surgical Data (Table 2)mentioning

confidence: 99%

“…In addition to that, some surgeons proceed to a prophylactic appendectomy and/or a caecopexy, which was not present in the original description. These manoeuvres have been abandoned by several centres in an effort to avoid associated complications (2).…”

mentioning

confidence: 99%

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

Arnaud

Suply

Eaton

et al. 2019

Journal of Pediatric Surgery

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“…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. 14,35 Redo was necessary for 10% of neonates/infants with only 2 (2%) presenting with volvulus, whereas in other 2 (2%), no abnormalities were found, and the authors reported that the indication for the second approach might have been due to their insecurity at the beginning of the learning curve.…”

Section: Discussionmentioning

confidence: 99%

“…42 The reasons for opponents of appendectomy include (1) increased risk of complications, 43 (2) possibility of future need an appendix for bowel management in cases with intestinal dysmotility/dysfunction, 44 and (3) role of the appendix in intestinal microbiota and possible association of appendectomy with other diseases, such as colorectal cancer and Chron's disease. 10,45,46 To date, there is no conclusive evidence for or against the removal of the appendix when operating on a neonate/ infant with intestinal malrotation. 10 Nevertheless, in cases without appendectomy, it is of paramount importance to inform the parents/caregivers about the possibility of atypical presentation of acute appendicitis.…”

Section: Discussionmentioning

confidence: 99%

“…9 Prophylactic appendectomy and/or cecopexy can be performed as part of the procedure, but some centers have abandoned them due to a lack of supportive evidence. 10 With the advances in minimal access surgery (MAS), the laparoscopic approach has gained popularity in neonatal and infant malrotation management. 11 In comparison to the open approach, MAS has advantages of reduced pain, decreased hospital stay, and shorter time to full feeds.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic Ladd Procedure for Malrotation in Newborns and Infants

Costa

Saxena

2020

The American Surgeon

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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.

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Prophylactic Procedures in Pediatric Surgery

Köylüoğlu

Öztan

2021

Prophylactic Surgery

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Let sleeping dogs lie: To leave the appendix at the time of a Ladd procedure

Cited by 6 publications

References 28 publications

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

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

Laparoscopic Ladd Procedure for Malrotation in Newborns and Infants

Prophylactic Procedures in Pediatric Surgery

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