Skip to main content
SpringerLink
Log in

Approach to intestinal malrotation in children in the laparoscopic era

  • Original Research
  • Published:
Journal of Pediatric Endoscopic Surgery Aims and scope Submit manuscript

Abstract

Aim

This study performed a systematic review of the laparoscopic approach to intestinal malrotation and compare the outcomes to the open approach in children.

Method

Medline/PubMed databases were reviewed and studies in patients < 18 years published in English/Spanish were included and selected by two independent reviewers. Demographics (age, weight, type of malrotation, type of surgery, conversions, comorbidity and complications) were collected. Descriptive statistics were used to analyze the quantities portion of the study, with results presented as percentages, means and medians.

Results

Between 1996 and 2019, 26 papers with 1828 patients from newborns to 13 years (median 7 years, mean 6.5 years) met the inclusion criteria. N = 457 (25%) patients were treated laparoscopic, n = 1055 (57.7%) open and no data on n = 316 (17.3%). The rate of laparoscopic conversion was 16.8% (n = 77). 14/26 articles described appendectomy as a part of Ladd’s procedure. 1/26 article (laparoscopy group) described cecopexy as a part of the procedure. There were 82 redo procedures (4.5%), 34 (7.4%) in the laparoscopy group and 41 (3.8%) in the open group (data not available n = 7). Complications were reported in n = 259 (14.2%), n = 62 (13.6%) in the laparoscopy group and n = 148 (14.0%) (n = 49 not specified). There were n = 4 lethal outcomes (0.4%) in the open cohort and none in the laparoscopic group.

Conclusions

Laparoscopic approach to malrotation in the pediatric age group is associated with a conversion rate of 16.8%. Poor reporting about the type of malrotation, co-mobidities and exact procedures performed needs to be improved to better evaluate outcomes both in laparoscopic and open procedures.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Millar AJ, Rode H, Cywes S (2003) Malrotation and volvulus in infancy and childhood. Semin Pediatr Surg 12:229–236

    Article  CAS  PubMed  Google Scholar 

  2. Martinez Ferro M, Cannizzaro C, Rodriguez S, et al. Intestinal malrotation Gaston E. In: Surgical neonatology, 2004, 1st edn. Grupo Guia, Buenos Aires (in press)

  3. Zellos A, Zarganis D, Ypsiladis S et al (2012) Malrotation of the intestine and chronic volvulus as a cause of protein-losing enteropathy in infancy. Pediatrics 129:e515–e518

    Article  PubMed  Google Scholar 

  4. Adams SD, Stanton MP (2014) Malrotation and intestinal atresias. Early Hum Dev 90:921–925

    Article  PubMed  Google Scholar 

  5. Dekonenko C, Sujka J, Weaver K et al (2019) The identification and treatment of intestinal malrotation in older children. Pediatr Surg Int 35:665–671

    Article  PubMed  Google Scholar 

  6. Vural V, Türkoğlu M, Karatasb G (2015) Incidental midgut malrotation detected during second laparotomy: case report and literature review. Int J Surg Case Rep 7:134–136

    Article  Google Scholar 

  7. Warner B (1997) Malrotation. In: Oldham KT, Colombani PM, Foglia RP (eds) Surgery of infants and children: scientific principles and practice. Lippincott Williams & Wilkins, Philadelphia, p 1229

    Google Scholar 

  8. Dilley AV, Pereira J, Shi EC (2000) The radiologist says malrotation: does the surgeon operate? Pediatr Surg Int 16:45

    Article  CAS  PubMed  Google Scholar 

  9. Berseth CL (1998) Disorders of the intestines and pancreas. In: Taeusch WH, Ballard RA (eds) Avery’s diseases of the newborn, 7th edn. WB Saunders, Philadelphia, p 918

    Google Scholar 

  10. Coste AH, Waheed A, Ahmad H (2019) Midgut volvulus. Stat Pearls Publishing, Treasure Island

    Google Scholar 

  11. Bill AH (1979) Malrotation of the intestine. In: Ravitch MM, Welch KJ, Benson CD et al (eds) Pediatric surgery. Year Book Medical, Chicago, pp 912–923

    Google Scholar 

  12. Wanjari AK, Deshmukh AJ, Tayde PS et al (2012) Midgut malrotation with chronic abdominal pain. N Am J Med Sci 4:196–198

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

  14. El-Gohary Y, Alagtal M, Gillick J (2010) Long-term complications following operative intervention for intestinal malrotation: a 10-year review. Pediatr Surg Int 26:203–206

    Article  PubMed  Google Scholar 

  15. Millar AJW, Rode H, Brown RA et al (1987) The deadly vomit: malrotation and midgut volvulus. Pediatr Surg Int 2:172–176

    Article  Google Scholar 

  16. Malek MM, Burd RS (2005) Surgical treatment of malrotation after infancy: a population-based study. J Pediatr Surg 40:285–289

    Article  PubMed  Google Scholar 

  17. Nehra D, Goldstein AM (2011) Intestinal malrotation: varied clinical presentation from infancy through adulthood. Surgery 149:386–393

    Article  PubMed  Google Scholar 

  18. Yoon JR, You SJ (2012) A case of midgut malrotation presenting as multiple afebrile seizures. Brain Dev 34:244–247

    Article  PubMed  Google Scholar 

  19. Lee HC, Pickard SS, Sridhar S et al (2012) Intestinal malrotation and catastrophic volvulus in infancy. J Emerg Med 43:e49–e51

    Article  PubMed  PubMed Central  Google Scholar 

  20. Messineo A, MacMillan JH, Palder SB et al (1992) Clinical factors affecting mortality in children with malrotation of the intestine. J Pediatr Surg 27:1343–1345

    Article  CAS  PubMed  Google Scholar 

  21. Langer J (2017) Intestinal rotation abnormalities and midgut volvulus. Surg Clin N Am 97:147–159. https://doi.org/10.1016/j.suc.2016.08.011

    Article  PubMed  Google Scholar 

  22. Carrol AG, Kavanagh RG, Leifhin N et al (2016) Comparative effectiveness of imaging modalities for the diagnosis of intestinal obstruction in neonates and infants: a critically appraised topic. Acad Radiol 23:559–568

    Article  Google Scholar 

  23. Orzech N, Navarro OM, Langer JC (2006) Is ultrasonography a good screening test for intestinal malrotation? J Pediatr Surg 41:1005–1009

    Article  PubMed  Google Scholar 

  24. Pumberger W, Kargl S (2012) Malposition of the intestine malposition malrotation volvulus “midgut volvulus”. Eur Surg 44(4):237–247. https://doi.org/10.1007/s10353-012-0102-y

    Article  Google Scholar 

  25. Ladd WE (1936) Surgical diseases of the alimentary tract in infants. N Engl J Med 215:705–708

    Article  Google Scholar 

  26. Van der Zee DC, Bax NM (1995) Laparoscopic repair of acute volvulus in a neonate with malrotation. Surg Endosc 9:1123–1124

    Article  PubMed  Google Scholar 

  27. Hsiao M, Langer JC (2012) Surgery for suspected rotation abnormality: selection of open vs laparoscopic surgery using a rational approach. J Pediatr Surg 47:904–910

    Article  PubMed  Google Scholar 

  28. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535

    Article  PubMed  PubMed Central  Google Scholar 

  29. Zhu H, Zheng S, Alganabi M et al (2019) Reoperation after Ladd’s procedure in the neonatal period. Pediatr Surg Int 35:117–120

    Article  PubMed  Google Scholar 

  30. Isani M, 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 

  31. Reddy A, Shah R, Kulkarni D (2018) Laparoscopic Ladd’s procedure in children: challenges, results, and problems. J Indian Assoc Pediatr Surg 23:61–65

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kisku S (2017) Orbit technique in malrotation with non-obstructive volvulus: a novel technique of devolvulation. Asian J Endosc Surg 10:213–215

    Article  PubMed  Google Scholar 

  33. Huntington J, Lopez J, Mahida J et al (2017) Comparing laparoscopic versus open Ladd’s procedure in pediatric patients. J Pediatr Surg 52:1128–1131

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  35. 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 25:155–158

    Article  PubMed  Google Scholar 

  36. Fernandez EM, Favre Rizzo J, Arteaga González I et al (2014) Left-sided appendicitis: diagnosis and minimally invasive treatment. Acta Gastroenterol Latinoam 44:62–66

    PubMed  Google Scholar 

  37. Hsiao M, Langer JC (2011) Value of laparoscopy in children with a suspected rotation abnormality on imaging. J Pediatr Surg 46:1347–1352

    Article  PubMed  Google Scholar 

  38. Nasir A, Abdur-Rahman L, Adeniran J (2011) Outcomes of surgical treatment of malrotation in children. Afr J Paediatr Surg 8:8–11

    Article  CAS  PubMed  Google Scholar 

  39. Hagendoorn J, Vieira-Travassos D, van der Zee D (2011) Laparoscopic treatment of intestinal malrotation in neonates and infants: retrospective study. Surg Endosc 25:217–220

    Article  PubMed  Google Scholar 

  40. Stanfill A, Pearl R, 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 20:369–372

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  42. Adikibi B, Strachan C, MacKinlay G (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 

  43. McVay M, Kokoska E, Jackson R et al (2007) Jack Barney Award. The changing spectrum of intestinal malrotation: diagnosis and management. Am J Surg 194:712–717

    Article  PubMed  Google Scholar 

  44. Palanivelu C, Rangarajan M, Shetty A et al (2007) Intestinal malrotation with midgut volvulus presenting as acute abdomen in children: value of diagnostic and therapeutic laparoscopy. J Laparoendosc Adv Surg Tech A 17:490–492

    Article  PubMed  Google Scholar 

  45. Draus J, Foley D, Bond S (2007) Laparoscopic Ladd procedure: a minimally invasive approach to malrotation without midgut volvulus. Am Surg 73:693–696

    PubMed  Google Scholar 

  46. Ten B, Tolboom J, Boetes C et al (2006) Surgical intervention of intestinal malrotations in paediatric patients without other congenital anatomical abnormalities: overview from a single center. Eur J Radiol 59:20–24

    Article  Google Scholar 

  47. Wu M, Hsu W, Lin W et al (2002) Laparoscopic Ladd’s procedure for intestinal malrotation: report of three cases. J Formos Med Assoc 101:152–155

    PubMed  Google Scholar 

  48. Yamashita H, Kato H, Uyama S et al (1999) Laparoscopic repair of intestinal malrotation complicated by midgut volvulus. Surg Endosc 13:1160–1162

    Article  CAS  PubMed  Google Scholar 

  49. Fernández M, Vila J, Ibáñez V et al (1999) Laparoscopic transsection of Ladd’s bands: a new indication for therapeutic laparoscopy in neonates. Cir Pediatr 12:41–43

    PubMed  Google Scholar 

  50. Bax N, van der Zee D (1998) Laparoscopic treatment of intestinal malrotation in children. Surg Endosc 12:1314–1316

    Article  CAS  PubMed  Google Scholar 

  51. Lessin M, Luks F (1998) Laparoscopic appendectomy and duodenocolonic dissociation (LADD) procedure for malrotation. Pediatr Surg Int 13:184–185

    Article  CAS  PubMed  Google Scholar 

  52. Mazziotti M, Strasberg S, Langer J (1997) Intestinal rotation abnormalities without volvulus: the role of laparoscopy. J Am Coll Surg 185:172–176

    Article  CAS  PubMed  Google Scholar 

  53. Waldhausen J, Sawin R (1996) Laparoscopic Ladd’s procedure and assessment of malrotation. J Laparoendosc Surg 6(Suppl 1):S103–S105

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Chelsea Children’s Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, 369 Fulham Road, London, SW10 9NH, UK

    Carmen Sofia Chacon & Amulya K. Saxena

Authors
  1. Carmen Sofia Chacon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amulya K. Saxena
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amulya K. Saxena.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chacon, C.S., Saxena, A.K. Approach to intestinal malrotation in children in the laparoscopic era. J Ped Endosc Surg 1, 137–142 (2019). https://doi.org/10.1007/s42804-019-00036-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s42804-019-00036-7

Keywords

Search

Navigation