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 ShenEmail author
Original Article


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.


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).


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.


Intestinal malrotation Ladd’s procedure Reoperation Laparoscopy Neonate 



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.


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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
    Email author
  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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