Outcomes of laparoscopic and open surgical treatment of intestinal malrotation in children

Scalabre, Aurélien; Duquesne, Igor; Deheppe, Jérome; Rossignol, Guillaume; Irtan, Sabine; Arnaud, Alexis; Ballouhey, Quentin; Abbo, Olivier; Rabattu, Pierre‐Yves; Binet, Aurélien; Varlet, François

doi:10.1016/j.jpedsurg.2020.08.014

Cited by 15 publications

(8 citation statements)

References 22 publications

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“…Due to their special pathophysiological and anatomical characteristics, neonates are vulnerable to AWD [12,16]. Neonatal low immunity, improper intraoperative operation and postoperative abdominal distension as reported before [19,20] are risk factors for neonatal AWD, which are related to the prognosis of neonatal AWD, but still cannot be used as biological indicators. Preoperative comprehensive assessment of the patient's overall nutritional status and appropriate perioperative operation has been considered to reduce the complications.…”

Section: Discussionmentioning

confidence: 99%

Prediction values of a novel prognostic index hypoproteinemia combined with contaminated wounds for wound dehiscence after abdominal surgery in neonates

Fu¹,

chen

et al. 2023

Preprint

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Background Abdominal Wound Dehiscence (AWD), occupying a large proportion of neonatal surgery is an essential complication of abdominal surgery, which can leads to severe consequences, including life-threatening. This study aims at exploring prediction value for AWD with potential joint factors of hypoproteinemia and incision type. Method The Cox proportional-hazards model (the Cox model) was applied to analyze clinical data came from 453 patients underwent neonatal laparotomy from June 2009 to June 2020. According to application of the random numbers, 453 cases were divided into two separate models randomly involving training set with 318 observations (70%) and validation set with 135 observations (30%), and then the models trained were validated based on the validation set. Investigation in the connection between hypoproteinemia, incision type, combined factors and AWD, were used for comparing those prediction values for AWD. Results With a median follow-up of 15 months, the incidence of neonatal AWD was 6.0% (27/453). Based on the univariate and multivariate Analysis using the Cox Regression Analysis, hypoproteinemia(HR = 7.005, P = 0.001) and joint factor༈HR = 6.901, P < 0.001༉were both the independent risk factors for neonatal AWD in training set. Meanwhile, hypoproteinemia and joint factor༈HR = 5.497, P = 0.045༉were both also the independent risk factors for neonatal AWD in validation models, which indicated that joint factor was the independent risk factor in both models. The summary ROC curve was estimated, and the area under the ROC curve (AUC) was calculated as a criterion for validating the models trained. The findings illustrated that AUC of joint prediction factor for AWD was higher than either that of hypoproteinemia༈0.759 vs. 0.638) or incision type factor ༈0.759 vs. 0.671༉singly. Conclusion The contribution of hypoproteinemia and incision type combined factor for predicting AWD is superior than that of them individually, resulting in a significant promotion in prediction efficiency and accuracy of predicting neonatal AWD.

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Section: Discussionmentioning

confidence: 99%

Prediction values of a novel prognostic index hypoproteinemia combined with contaminated wounds for wound dehiscence after abdominal surgery in neonates

Fu¹,

chen

et al. 2023

Preprint

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“…7,8 A recent study suggested that conversion to open surgery should be done with a low threshold. 3 The cause of high recurrence risk on laparoscopic surgery in comparison to laparotomy may depend on two methods. The first limitation of the laparoscopic Ladd's surgery is the volvulus correction due to lack of pan-view in the bowel tracing method.…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic Ladd's surgery carries an increased risk incidence of postoperative recurrence of volvulus but a reduced time to full enteral feeding and hospital stay duration 7,8 . A recent study suggested that conversion to open surgery should be done with a low threshold 3 …”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic surgery for intestinal malrotation was first reported by van der Zee, 2 but its safety remains controversial. 3 A prospective study reported that the incidence of reoperation did not markedly differ between laparoscopic Ladd's surgery for neonates and open surgery, but the incidence of recurrent Abbreviations: FI, fluorescence imaging; ICG, indocyanine green; SMA, superior mesenteric artery; SMV, superior mesenteric vein. midgut volvulus was higher with laparoscopic surgery (5.1%; open surgery, 0.5%).…”

Section: Introductionmentioning

confidence: 99%

“…This approach is broadly divided into repairing rotation, dissection of Ladd's ligament, broadening of the mesenteric root, and alignment of the intestine and colon from the right to the left side of the abdomen. Laparoscopic surgery for intestinal malrotation was first reported by van der Zee, 2 but its safety remains controversial 3 . A prospective study reported that the incidence of reoperation did not markedly differ between laparoscopic Ladd's surgery for neonates and open surgery, but the incidence of recurrent midgut volvulus was higher with laparoscopic surgery (5.1%; open surgery, 0.5%) 4 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A safe and effective laparoscopic Ladd's procedure technique involving the confirmation of mesenteric vascular perfusion by fluorescence imaging using indocyanine green: A case report of an infant

Sugita

Onishi

Kedoin

et al. 2022

Asian J Endoscop Surgery

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We herein report a 20‐month‐old boy who underwent laparoscopic Ladd's surgery. He showed intermittent bilious vomiting after birth and received a definitive diagnosis of intestinal malrotation. Laparoscopic Ladd's procedure was performed with four trocars. Midgut volvulus (180° counterclockwise) was resolved by retrogradely tracing the small intestine from the ileocecal region. After dividing Ladd's ligament, fluorescent navigation with indocyanine green was used. We decided where to dissect the mesenteries by confirming the vascular perfusion through clamping the tissue. Fibrous adhesions were gradually dissected, and it was confirmed that the mesenteric root was sufficiently broadening. Surgeons hesitate to dissect the mesenteric root in laparoscopic procedures compared with open procedures because of the narrow operative view and the risk of vascular injury. Laparoscopic Ladd's procedure using indocyanine green to confirm intestinal blood flow is safe and useful for the small working space in pediatric patients with intestinal malrotation and midgut volvulus.

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Robotic-Assisted Ladd’s Procedure for Congenital Malrotation

Tou,

Huang

2023

Pediatric Robotic Surgery

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Outcomes of laparoscopic and open surgical treatment of intestinal malrotation in children

Cited by 15 publications

References 22 publications

Prediction values of a novel prognostic index hypoproteinemia combined with contaminated wounds for wound dehiscence after abdominal surgery in neonates

Prediction values of a novel prognostic index hypoproteinemia combined with contaminated wounds for wound dehiscence after abdominal surgery in neonates

A safe and effective laparoscopic Ladd's procedure technique involving the confirmation of mesenteric vascular perfusion by fluorescence imaging using indocyanine green: A case report of an infant

Robotic-Assisted Ladd’s Procedure for Congenital Malrotation

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