Approach to intestinal malrotation in children in the laparoscopic era

Abstract

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