Long-term complications following operative intervention for intestinal malrotation: a 10-year review

Abstract

Intestinal malrotation associated with a volvulus requires immediate surgical intervention. The long-term sequelae of Ladd's procedure and its complications are not well defined. We designed this study to investigate the long-term complications following operative intervention for intestinal malrotation. Patients who have undergone a Ladd's procedure for malrotation from January 1999 till December 2008, from two tertiary centres, were identified using the Hospital Inpatient Enquiry system. Charts were analysed to obtain information about mode of presentation, method of diagnosis and postoperative outcomes. Patients were contacted for follow-up. One hundred and sixty-one patients were identified over the 10-year period with a postoperative follow-up time ranging from 2 months to 10 years. The median age at surgery was 9 days (1 day-12 years); 38 (23%) underwent elective Ladd's procedure for malrotation. Thirty-eight patients had intraoperative incidental findings of a malrotation during different procedures; 120 (74.5%) patients were performed as an emergency procedure. Fourteen patients (8.7%) developed complications following surgery. Nine patients developed adhesive small bowel obstruction, five required operative adhesiolysis having failed conservative treatment. There was one case of recurrent volvulus and three mortalities in our series. In our experience, looking at 161 patients with a mean follow-up of 5 years Ladd's procedure has a low postoperative morbidity and remains a vital treatment for malrotation in children.