Laparoscopic Ladd's procedure in infants with malrotation

Purpose: This clinical study was undertaken to examine the feasibility of a laparoscopic approach for the treatment of documented malrotation. Methods: From May 1994 through January of 1997, 12 patients, aged 5 days to 4 months, weighing 3 to 7 kg, underwent laparoscopic Ladd's procedure for ma...

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Bibliographic Details
Published in:Journal of pediatric surgery 1998-02, Vol.33 (2), p.279-281
Main Authors: Bass, Kathryn D, Rothenberg, Steven S, Chang, Jack H.T
Format: Article
Language:English
Subjects:
Biological and medical sciences
Congenital Abnormalities - surgery
Feasibility Studies
Humans
Infant
Infant, Newborn
Intestinal Obstruction - etiology
Intestinal Obstruction - surgery
Intestines - abnormalities
Laparoscopy - methods
Medical sciences
Pierre Robin Syndrome - complications
Stomach, duodenum, intestine, rectum, anus
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Time Factors
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Summary:Purpose: This clinical study was undertaken to examine the feasibility of a laparoscopic approach for the treatment of documented malrotation. Methods: From May 1994 through January of 1997, 12 patients, aged 5 days to 4 months, weighing 3 to 7 kg, underwent laparoscopic Ladd's procedure for malrotation. All patients had symptoms of intermittent upper intestinal obstruction, and malrotation was documented by an upper gastrointestinal contrast study. None of the patients had acute volvulus or compromised bowel. The procedure was performed using 3 trocars of 3.5 mm diameter. Ports were placed in the infraumbilical ring, and the right and left mid to lower quadrants. A standard Ladd's procedure with appendectomy was performed in all cases. Results: All procedures were completed successfully through the laparoscope. Operative times averaged 58 minutes (35 to 120 minutes). One patient with Pierre-Robin underwent a laparoscopic Nissen fundoplication and gastrostomy tube placement at the same time requiring 120 minutes. Feedings were started on postoperative day (POD) 1 in 10 cases and POD 2 in two cases. Hospital stay ranged from 2 to 4 days (average, 2.2) in the patients with isolated malrotation. The patient with Pierre-Robin had a prolonged hospitalization because of chronic respiratory problems not associated with surgery. There were no complications. All patients had resolution of their symptoms. Conclusions: Laparoscopic Ladd's procedure is a safe and effective technique. It can be performed in neonates in times equivalent to standard open techniques, and it appears to allow for earlier feeds and decreased hospital stays.
ISSN:0022-3468
1531-5037
DOI:10.1016/S0022-3468(98)90447-X