Objective: With increasing use of minimally invasive techniques, laparoscopic Ladd’s procedure is increasingly utilized to treat children with malrotation, yet evidence regarding its safety and efficacy is lacking. We... [ view full abstract ]
Objective: With increasing use of minimally invasive techniques, laparoscopic Ladd’s procedure is increasingly utilized to treat children with malrotation, yet evidence regarding its safety and efficacy is lacking. We hypothesize that operative and post-operative outcomes with the open technique are superior to the laparoscopic Ladd’s procedure.
Methods: We conducted a five-year retrospective chart review of all patients who underwent Ladd’s procedure at our institution from 2010-2015. Exclusion of patients included those with concomitant conditions, such as poor gut perfusion, significant reflux, tracheoesophageal fistula, and biliary atresia. Two-tailed unpaired t-tests were utilized.
Results: Between 2010-15, of 92 patients who underwent Ladd’s procedure, 78 met inclusion criteria. Sixty-five patients underwent initial open surgery, 13 patients underwent laparoscopy, 6 of which were converted to open. Patients undergoing open surgery were younger compared to the laparoscopic patients (mean age: 1.9±0.5 yrs vs. 8.0±2.9 yrs, p=0.001). Seventeen of the 78 malrotation patients (22%) presented with volvulus; 13 underwent open surgery, 3 had laparoscopic converted to open procedures, and 1 patient underwent laparoscopic Ladd’s without incident. Laparoscopy resulted in increased operative time (2.2h vs. 1.2h, p=0.002) and longer time to resume diet (11d vs. 5.3d, p=0.033). Length of hospital stay, readmission rates, and reoperation rates were not statistically significant between groups.
Conclusion: Although minimally invasive approaches are becoming increasingly used, no evidence supports laparoscopic superiority over open Ladd’s procedure. We found that open surgery was associated with shorter operating times and faster resumption of diet. Furthermore, laparotomy remains the favored procedure for patients presenting with volvulus.