Skip to main content
Log in

Reoperation after Ladd’s procedure in the neonatal period

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Langer JC (2017) Intestinal rotation abnormalities and midgut volvulus. Surg Clin N Am 97(1):147–159

    Article  PubMed  Google Scholar 

  2. Zani A, Pierro A (2017) Intestinal malrotation. In: Puri P (ed) Newborn surgery, 4th edn. CRC Press, Boca Raton

    Google Scholar 

  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):318–321

    Article  PubMed  Google Scholar 

  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):61–65

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ezer SS, Oguzkurt P, Temiz A et al (2016) Intestinal malrotation needs immediate consideration and investigation. Pediatr Int 58(11):1200–1204

    Article  PubMed  Google Scholar 

  6. Lakshminarayanan B, Hughes-Thomas AO, Grant HW (2014) Epidemiology of adhesions in infants and children following open surgery. Semin Pediatr Surg 23(6):344–348

    Article  PubMed  Google Scholar 

  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):369–372

    Article  PubMed  Google Scholar 

  8. Ingoe R, Lange P (2007) The Ladd’s procedure for correction of intestinal malrotation with volvulus in children. AORN J 85(2):300–308

    Article  PubMed  Google Scholar 

  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):658–663

    Article  PubMed  Google Scholar 

  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):203–206

    Article  Google Scholar 

  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–S170

    Article  PubMed  Google Scholar 

  12. Fraser JD, Aguayo P, Sharp SW et al (2009) The role of laparoscopy in the management of malrotation. J Surg Res 156(1):80–82

    Article  PubMed  Google Scholar 

  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):217–220

    Article  PubMed  Google Scholar 

  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):1128–1131

    Article  PubMed  Google Scholar 

  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):155–158

    Article  PubMed  Google Scholar 

  16. Ooms N, Matthyssens LE, Draaisma JM et al (2016) Laparoscopic treatment of intestinal malrotation in children. Eur J Pediatr Surg 26(4):376–381

    Article  PubMed  Google Scholar 

  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):1157–1164

    Article  PubMed  Google Scholar 

  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 229:351–356

    Article  PubMed  Google Scholar 

  19. Kinlin C, Shawyer AC (2017) The surgical management of malrotation: a Canadian Association of Pediatric Surgeons survey. J Pediatr Surg 52(2):853–858

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Chun Shen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhu, H., Zheng, S., Alganabi, M. et al. Reoperation after Ladd’s procedure in the neonatal period. Pediatr Surg Int 35, 117–120 (2019). https://doi.org/10.1007/s00383-018-4382-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-018-4382-6

Keywords

Navigation