Background
Malrotation is currently treated via the Ladd's procedure. Many surgeons feel this
operation should be performed using the open approach to facilitate adhesion development,
thus decreasing the risk for volvulus. However, little comparative data exist on the
relative merits of laparoscopy for this operation. Therefore, we have analyzed our
experience with the open and laparoscopic Ladd's procedure.
Methods
A retrospective analysis of our most recent 13-y experience with the Ladd's procedure
was performed. Demographics, approach, diagnosis, hospital course, and outcomes were
measured. Data are expressed as mean ± standard deviation. Comparative analysis was
performed using a t-test.
Results
A total of 284 Ladd's procedures were performed during this time, of which 43 were
approached laparoscopically. Conversion rate was 33%, usually due to concern for volvulus/orientation.
Volvulus after Ladd's procedure occurred in six patients, all of whom underwent an
open approach (2.4%). Recovery data excluding patients who underwent bowel resection
are displayed in Table 1.
Conclusions
A laparoscopic Ladd's procedure should be the initial approach in patients with malrotation
in the absence of volvulus. We encourage a low threshold for conversion to an open
approach if there is any concern about volvulus/orientation. This may decrease morbidity
for patients who are found at operation to have a low risk of recurrent volvulus.
Key Words
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Article info
Publication history
Published online: May 01, 2009
Received:
January 6,
2009
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
