Comparison of late results in patients with corrected intestinal malrotation with and without fixation of the mesentery

Abstract

Between 1940 and 1975, 86 patients with malrotation of the intestine leading to intestinal obstruction or volvulus were treated at the University Children's Hospital of Zürich. All case histories and radiograms have been examined and a questionnaire has been sent to all surviving patients. Forty-four of them were reexamined personally 3 to 37 yr later. The study was undertaken to find out whether at the time of correction of intestinal malrotation simultaneous additional fixation of the mesentery had any value. Six of the 86 patients were successfully treated nonoperatively and 3 died before surgery of other severe malformations. Of the remaining 77 children who underwent surgery, additional fixation was done in 28 of the earlier cases, but not done in 49 of the later cases. The percentage of early survivors was 85.7% in the group with intestinal fixation and 83.7% in the group without fixation. The number of reoperations was slightly lower in the group without fixation (10.4%) when compared to the group with fixation (16.6%). 25% of the children with intestinal fixation and 21% of the children without fixation had occasionally slight abdominal symptoms at a later time. These results demonstrate that intestinal fixation neither increased the number of early survivors nor reduced the number of reoperations, nor the percentage of children with abdominal complaints. It was therefore concluded that additional fixation after correction of intestinal malrotations was of no benefit and unnecessary.