Laparoscopic Ladd Procedure for Correction of Pediatric Malrotation: Initial Experience

Abstract

Introduction:

Malrotation without midgut volvulus can cause chronic, intermittent symptoms and produce potentially disastrous consequences if left untreated. Upper gastrointestinal x-ray series (UGI) in such patients often suggest a rotational anomaly but may not be completely diagnostic.

Methods:

Thirteen children, aged 3 months to 14 years, suspected of having malrotation without volvulus based on preoperative symptoms and UGI, underwent laparoscopic exploration by a single surgeon over a 21 month period.

Results:

Ten of 13 (77%) were confirmed to have malrotation and underwent laparoscopic correction. Operative time ranged from 80 to 209 minutes (mean, 134 minutes) with minimal blood loss. Feedings were started within 24 hours in 6 (60%) and within 72 hours in the remaining 4 (40%). Full feedings were tolerated by postoperative day (POD) 4 in all patients. Hospital stay ranged from 1 to 4 days (mean, 2.8 days). Two of the three children with negative laparoscopies were discharged by POD 1. Followup has ranged from 5 to 22 months. Emesis resolved in 7 of 8 surgically corrected patients (2 patients were lost to followup). No patient developed midgut volvulus nor required reoperation.

Conclusion:

In the subset of children with intermittent obstructive symptoms and an abnormal UGI, laparoscopy permits diagnostic certainty, symptom relief similar to open Ladd procedure, yet avoids the morbidity of traditional laparotomy.