The role of laparoscopy in the management of malrotation

Abstract

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.