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Pediatric Surgery International

, Volume 35, Issue 1, pp 117–120 | Cite as

Reoperation after Ladd’s procedure in the neonatal period

  • Haitao Zhu
  • Shan Zheng
  • Mashriq Alganabi
  • Xueni Peng
  • Kuiran Dong
  • Agostino Pierro
  • Chun Shen
Original Article
  • 69 Downloads

Abstract

Aim of the study

To investigate (1) the indications for reoperation after neonatal Ladd’s procedure, (2) the type of reoperation and (3) its outcome.

Methods

We reviewed all neonatal Ladd’s procedures in our hospital from 2003 to 2017 and the outcomes of reoperation in these patients.

Main results

252 neonates had Ladd’s procedure: 59 were laparoscopic (23.4%) and 193 open (76.6%). 15 (6.0%) required reoperation with no difference between laparoscopic and open (p = 0.12). Overall, the indications for reoperation were: adhesive intestinal obstruction (n = 10, 4.0%), recurrent midgut volvulus (n = 4, 1.6%), and missed diagnosis of associated anomaly (n = 1, 0.4%). The incidence of recurrent midgut volvulus was higher after laparoscopic Ladd’s procedure (3/59; 5.1%) compared to open Ladd’s procedure (1/193; 0.5%) (p = 0.04). Adhesive intestinal obstruction developed after both open (8/193, 4.1%) or laparoscopic Ladd’s procedure (2/59, 3.3%). The duration of reoperation and the length of post-operative hospital stay were 63.4 ± 27.1 min and 10.1 ± 5.2 days, respectively. After reoperation, there were no post-operative complications. All children were well at follow-up (6 months–14 years).

Conclusions

In neonates, laparoscopic Ladd’s procedure compared to the open Ladd’s procedure is associated with a significantly higher risk of recurrent volvulus. The risk of developing this potentially dangerous complication after laparoscopic Ladd’s procedure raises doubts about the effectiveness and safety of the laparoscopic approach in neonates.

Keywords

Intestinal malrotation Ladd’s procedure Reoperation Laparoscopy Neonate 

Notes

Acknowledgements

This work was supported by Shanghai Hospital Development Center (SHDC, 12014106) and Shanghai Key Disciplines (no. 2017ZZ02022).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Langer JC (2017) Intestinal rotation abnormalities and midgut volvulus. Surg Clin N Am 97(1):147–159CrossRefGoogle Scholar
  2. 2.
    Zani A, Pierro A (2017) Intestinal malrotation. In: Puri P (ed) Newborn surgery, 4th edn. CRC Press, Boca RatonGoogle Scholar
  3. 3.
    Ferrero L, Ahmed YB, Philippe P et al (2017) Intestinal malrotation and volvulus in neonates: laparoscopy versus open laparotomy. J Laparoendosc Adv Surg Tech A 27(3):318–321CrossRefGoogle Scholar
  4. 4.
    Reddy AS, Shah RS, Kulkarni DR (2018) Laparoscopic Ladd’s procedure in children: challenges, results, and problems. J Indian Assoc Pediatr Surg 23(2):61–65CrossRefGoogle Scholar
  5. 5.
    Ezer SS, Oguzkurt P, Temiz A et al (2016) Intestinal malrotation needs immediate consideration and investigation. Pediatr Int 58(11):1200–1204CrossRefGoogle Scholar
  6. 6.
    Lakshminarayanan B, Hughes-Thomas AO, Grant HW (2014) Epidemiology of adhesions in infants and children following open surgery. Semin Pediatr Surg 23(6):344–348CrossRefGoogle Scholar
  7. 7.
    Stanfill AB, Pearl RH, Kalvakuri K et al (2010) Laparoscopic Ladd’s procedure: treatment of choice for midgut malrotation in infants and children. J Laparoendosc Adv Surg Tech A 20(4):369–372CrossRefGoogle Scholar
  8. 8.
    Ingoe R, Lange P (2007) The Ladd’s procedure for correction of intestinal malrotation with volvulus in children. AORN J 85(2):300–308CrossRefGoogle Scholar
  9. 9.
    Durkin ET, Lund DP, Shaaban AF et al (2008) Age-related differences in diagnosis and morbidity of intestinal malrotation. J Am Coll Surg 206(4):658–663CrossRefGoogle Scholar
  10. 10.
    EI-Gohary Y, Alagtal M, Gillick J (2010) Long-term complications following operative intervention for intestinal malrotation: a 10-year review. Pediatr Surg Int 26(2):203–206CrossRefGoogle Scholar
  11. 11.
    Adikibi BT, Strachan CL, MacKinlay GA et al (2009) Neonatal laparoscopic Ladd’s procedure can safely be performed even if the bowel shows signs of ischemia. J Laparoendosc Adv Surg Tech A 19(Suppl 1):S167–S170CrossRefGoogle Scholar
  12. 12.
    Fraser JD, Aguayo P, Sharp SW et al (2009) The role of laparoscopy in the management of malrotation. J Surg Res 156(1):80–82CrossRefGoogle Scholar
  13. 13.
    Hagendoorn J, Vieira-Travassos D, van der Zee D (2011) Laparoscopic treatment of intestinal malrotation in neonates and infants: retrospective study. Surg Endosc 25(1):217–220CrossRefGoogle Scholar
  14. 14.
    Huntington JT, Lopez JJ, Mahida JB et al (2017) Comparing laparoscopic versus open Ladd’s procedure in pediatric patients. J Pediatr Surg 52(7):1128–1131CrossRefGoogle Scholar
  15. 15.
    Miyano G, Fukuzawa H, Morita K et al (2015) Laparoscopic repair of malrotation: what are the indications in neonates and children? J Laparoendosc Adv Surg Tech A 25(2):155–158CrossRefGoogle Scholar
  16. 16.
    Ooms N, Matthyssens LE, Draaisma JM et al (2016) Laparoscopic treatment of intestinal malrotation in children. Eur J Pediatr Surg 26(4):376–381CrossRefGoogle Scholar
  17. 17.
    Catania VD, Lauriti G, Pierro A et al (2016) Open versus laparoscopic approach for intestinal malrotation in infants and children: a systematic review and meta-analysis. Pediatr Surg Int 32(12):1157–1164CrossRefGoogle Scholar
  18. 18.
    Isani MA, Schlieve C, Jackson J et al (2018) Is less more? Laparoscopic versus open Ladd’s procedure in children with malrotation. J Surg Res 229:351–356CrossRefGoogle Scholar
  19. 19.
    Kinlin C, Shawyer AC (2017) The surgical management of malrotation: a Canadian Association of Pediatric Surgeons survey. J Pediatr Surg 52(2):853–858CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Haitao Zhu
    • 1
    • 2
  • Shan Zheng
    • 1
  • Mashriq Alganabi
    • 2
  • Xueni Peng
    • 1
  • Kuiran Dong
    • 1
  • Agostino Pierro
    • 2
  • Chun Shen
    • 1
  1. 1.Department of Pediatric SurgeryChildren’s Hospital of Fudan UniversityShanghaiChina
  2. 2.Division of General and Thoracic Surgery, Translational Medicine ProgramThe Hospital for Sick ChildrenTorontoCanada

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