Laparoscopic diagnosis and treatment for intestinal malrotation in children

Abstract

Objective To evaluate the effectiveness of a laparoscopic approach for the diagnosis and surgical treatment of intestinal malrotation, and to explore the optimal repairing conditions for midgut volvulus. Methods From July 2002 to March 2008, twenty-three children with suspected intestinal malrotation underwent the diagnostic laparoscopy. There were 13 males and 10 females. The age of patients ranged from 5 days to 12 years, with the average of 1.9 years. The laparoscopic procedure was performed with 3 troears to make a diagnosis. Under laparoscopic vision, the reposition of malrotated intestine was done by manual grasping and pulling, Ladd's band was incised, the duodenum and proximal jejunum were mobilized, and the concomitant abnormities were treated at the same time. Results Twenty-three cases suffered from intestinal malrotation were managed by Ladd's operation under laparoscope. Eighteen cases with midgut volvulous from 270 to 960 degree were corrected successfully, among whom, two cases were found with paraduodenal hernia, 1 with duodenal web, 1 with ectopic pancreas and 1 with Meckel's diverticulum. All of the incidental findings above had surgical treatment meanwhile with the Ladd's operation. The average operative time was 65.2 ± 15.8 min (ranging from 35 to 150 mins). Feedings were started on 1 to 3 days postoperatively with no complications. But one case underwent the second operation for proximal jejunal adhension 2 months later after operation. Twenty-one patients had been followed up from 1 month to 5 years, all of whom got satisfactory growth and development. Conclusions The intestinal malrotation can be diagnosed and treated with laparoseopy which can be performed in neonates securely and applied for a subacute midgut volvulus. Patients also benefit from this minimally invasive approach with earlier oral intake, shorter period of hospitalization and more aesthetic scar on skin. Key words: Laparoscopes; Intestinal diseases