Laparoscopic diagnosis and treatment of complex intestinal malrotation: a report of 7 cases

Abstract

Objective To summarize our preliminary experiences of laparoscopic diagnosis and treatment for complex intestinal malrotation. Methods A retrospective review was performed for the laparoscopic diagnosis and treatment for 7 children of complex intestinal malrotation from June 2011 to January 2014. Their mean age was 9.3 months (1 day to 4 years) and their minimum weight 2.5 kg. A 5-mm port was placed at umbilicus for a 300 laparoscope and the second and third ports were inserted at the right lower and upper abdomen just lateral to the edge of rectus abdominis muscle. An extra port could be placed in left upper quadrant for aiding operation. Two cases were complicated with annular pancreas. And Ladd's procedure and duodenal diamond anastomosis were performed; one case was complicated with left-sided perforated appendicitis. And Ladd's procedure, appendectomy, peritoneal lavage and drainage were accomplished laparoscopiclly; One case was complicated with Amyand's hernia. And Ladd's procedure, appendectomy and herniorrhaphy were performed; one case was associated with Waugh's syndrome. And laparoscopic reduction of intussusception and Ladd's procedure were accomplished; one case complicated with duodenal atresia and multiple jejunal atresias converted into open surgery. Results All cases were diagnosed laparoscopiclly and 6 of them underwent laparoscopy. The mean operative duration was 125(90-150) min. Intraoperative bleeding volume was 2-10 ml without necessity for blood transfusion or intraoperative complications. Feeding was started at a mean of postoperative day 5.4 (3-13). Discharge was made at a mean of postoperative day 11 (8-16). The mean follow-up period was 7.8(2-20) months. One case of chylous ascites complicated with incomplete intestinal obstruction at 2 months post-operation was cured conservatively. And the remainder recovered well. Conclusions Diagnosis and operating method may be determined laparoscopically. Laparoscopic Ladd's procedure is both effective and safe. And conversion into open surgery is adopted when it is necessary. Key words: Laparoscopes; Intestinal malrotation; Child