Outcome of laparoscopic diagnosis and treatment of intestinal malrotation in infants and young children

Abstract

Objective The aim of this study was to evaluate the safety and efficacy of laparoscopy in the diagnosis and treatment of intestinal malrotation in infants and young children. Patients and methods Diagnostic laparoscopy was performed on 27 infants and young children aged 4 months-5 years with suspected intestinal malrotation on clinical examination, imaging studies, or both. All patients with malrotation on exploration were treated with laparoscopic Ladd's procedure. After completion of laparoscopic Ladd's procedure, patients were followed up for 3-18 months. Results On diagnostic laparoscopy, seven patients (26%) with normal rotation, two patients (7.4%) with volvulus converted to open surgery, and 18 patients (66.6%) with malrotation only underwent laparoscopic Ladd's procedure. The rate of conversion to laparotomy was 18.5% in all patients and 11.1% in patients who underwent laparoscopic Ladd's. There was a significant association between presence of malrotation and preoperative presentation with bilious emesis. Sixteen patients completed laparoscopic Ladd's procedure for mlarotation with an average operative time of 46 ± 16 min, an average time to normal feeding of 2.7 ± 1 days, and an average postoperative hospital stay of 4.8 ± 2 days. There were no early postoperative complications, and there were no cases with late volvulus. Wound infection occurred in one patient who underwent open approach for volvulus and early adhesive small bowel obstruction in another patient who underwent open laparoscopic Ladd's. Conclusion Laparoscopy is a safe and effective method in the diagnosis and treatment of intestinal malrotation in infants and young children, with or without preoperative symptoms.