Ladd Procedure Research Articles

Is less more? Laparoscopic versus open Ladd's procedure in children with malrotation

BackgroundWith the advent of minimally invasive techniques, laparoscopic Ladd's procedure is increasingly used to treat children with malrotation, yet evidence regarding its safety and efficacy is lacking. We hypothesize that operative and postoperative outcomes with the open technique are superior to the laparoscopic Ladd's procedure. MethodsWe conducted a 5-y retrospective chart review of all patients who underwent Ladd's procedure at our institution from 2010-2015. Exclusion of patients included those with concomitant conditions, such as poor gut perfusion, significant reflux, tracheoesophageal fistula, failure to thrive requiring concomitant gastrostomy, and biliary atresia. Kruskal–Wallis and Mann–Whitney tests were used where appropriate. ResultsBetween 2010 and 2015, of 130 patients who underwent Ladd's procedure, 77 met inclusion criteria. Sixty-two patients underwent initial open surgery, 15 patients underwent laparoscopy, seven of which were converted to open. Patients undergoing open surgery were younger compared to the laparoscopic groups. Thirty-three of the 77 malrotation patients (43%) presented with volvulus, 27 underwent open surgery, four had laparoscopic converted to open procedures, and two patients underwent laparoscopic Ladd's without incident. Laparoscopy resulted in increased operative time and clinic visits. Patients undergoing laparoscopic to open surgery had longer operative times, time to resume diet, and length of hospital stay. No difference was noted in complications among the groups. ConclusionsAlthough minimally invasive approaches are becoming increasingly used, no evidence supports laparoscopic superiority over open Ladd's procedure. We found that open surgery was associated with shorter operating times and fewer clinic visits. Furthermore, laparotomy remains the favored procedure for patients presenting with volvulus.

Sonographic Findings of Midgut Malrotation With Volvulus: A Case of Upper Intestinal Obstruction in a Neonate

Midgut malrotation is a congenital condition resulting from incomplete normal intestinal rotation after physiologic gut herniation. While it can remain asymptomatic over an entire lifetime, midgut volvulus is most likely to occur during early life. While an upper gastrointestinal series is the imaging modality of choice for definitive diagnosis, sonography is a safe and effective modality capable of indicating midgut malrotation, especially in pediatric patients. This case study illustrates the sonographic findings associated with intestinal malrotation with volvulus and discusses the etiology, signs, symptoms, and treatment of the condition. In addition, the sonographic findings are correlated with upper gastrointestinal results, which confirmed midgut malrotation. The diagnosis of volvulus secondary to midgut malrotation was confirmed by a laparoscopic Ladd procedure performed to treat the neonate.

Is isomerism a risk factor for intestinal volvulus?

IntroductionIsomerism, or heterotaxy syndrome, affects many organ systems anatomically and functionally. Intestinal malrotation is common in patients with isomerism. Despite a low reported risk of volvulus, some physicians perform routine screening and prophylactic Ladd procedures on asymptomatic patients with isomerism who are found to have intestinal malrotation. The primary aim of this study was to determine if isomerism is an independent risk factor for volvulus. MethodsKid's Inpatient Database data from 1997 to 2012 was utilized for this study. Characteristics of admissions with and without isomerism were compared with a particular focus on intestinal malrotation, volvulus, and Ladd procedure. A logistic regression was conducted to determine independent risk factors for volvulus with respect to isomerism. Results15,962,403 inpatient admissions were included in the analysis, of which 7970 (0.05%) patients had isomerism, and 6 patients (0.1%) developed volvulus. Isomerism was associated with a 52-fold increase in the odds of intestinal malrotation by univariate analysis. Of 251 with isomerism and intestinal malrotation, only 2.4% experienced volvulus. Logistic regression demonstrated that isomerism was not an independent risk factor for volvulus. ConclusionIsomerism is associated with an increased risk of intestinal malrotation but is not an independent risk factor for volvulus. Type of StudyPrognosis study. Level of EvidenceLevel III.

Malrotation is not associated with adverse outcomes after cardiac surgery in patients with heterotaxy syndrome

BackgroundPatients with heterotaxy syndrome (HS) often have asymptomatic malrotation. There is a lack of consensus regarding the management of these patients, particularly in patients with complex congenital heart disease (CHD). We sought to describe the prevalence of malrotation and incidence of volvulus in a population of patients with complex CHD and to identify the impact of malrotation on morbidity and mortality following cardiac surgery. MethodsWe performed a retrospective review of all patients with HS and complex CHD who required cardiac surgery in the first year of life at a single center between October 1995 and September 2015. Malrotation was diagnosed by abdominal imaging or by direct inspection during abdominal surgery. Demographic data was collected along with details of hospitalization following cardiac and GI surgeries. Descriptive analysis along with appropriate hypothesis testing was conducted to evaluate the results. ResultsWe identified 49 patients with HS, 42 with single ventricle anatomy and 7 with biventricular anatomy. Of the 49 patients, 29 (59%) were diagnosed with malrotation, 6 (12%) had normal intestinal rotation, and 14 (29%) had no evaluation of intestinal rotation. The prevalence of malrotation in the population who underwent abdominal imaging was 29 out of 35 (83%). There was no difference in survival following cardiac surgery between patients with malrotation and those with unknown or normal intestinal anatomy. Comparing patients with malrotation and patients with normal or unknown intestinal rotation, there was also no difference in surrogate markers of morbidity. Of the 29 patients with known malrotation, only 2 patients (7%) underwent therapeutic Ladd procedures and 19 (65%) underwent prophylactic Ladd procedures. ConclusionsWe conclude that the outcomes following cardiac surgery for patients with HS are not impacted by the presence of malrotation. Furthermore, we also found that the incidence of volvulus in the studied group is low. Given these findings, and the understanding that patients with HS and significant CHD are frequently tenuous and high risk surgical candidates, we do not believe performing prophylactic Ladd procedures is warranted. Level of evidenceIII.

Laparoscopic Ladd'S Procedure in Children: Challenges, Results, and Problems.

Background:Laparoscopic correction of malrotation in children is challenging. Authors review their experience with indications, results and problems of laparoscopic correction of malrotation.Materials and Methods:This is a retrospective study of 41 cases of children who were diagnosed as Intestinal malrotation on clinical and radiological evaluation.Results:Successful laparoscopic Ladd's procedure was accomplished in 35 cases. There were six conversions to open surgery. The mean hospital stay was 4 days (range 3-12days). Restoration of complete feed was achieved on an average of 3 days (range 2-4days). Post-operative recurrence of symptoms was seen in nine cases. Of which, five cases had incomplete correction, three cases had duodenal kinking due to adhesive intestinal obstruction and one had intra luminal duodenal obstruction. All patients underwent open surgery for recurrent symptoms.Conclusion:Laparoscopic Ladd's procedure is feasible in children with intestinal malrotation with or without associated volvulus. However, some of them need conversion to open surgery due to difficult local anatomy. For persistent symptoms, they may require redo surgery, which may be due to incomplete correction, adhesive obstruction or intraluminal obstruction.

Laparoscopic diagnostic finding in atypical intestinal malrotation in children with equivocal imaging studies.

Background:Atypical presentation of intestinal malrotation provide a diagnostic and therapeutic dilemma for the surgeon to answer the question is it wisdom to operate or not? Upper gastrointestinal (UGI) contrast study is essential for diagnosis; however, 'soft’ radiologic findings place the responsibility of excluding malrotation directly on the surgeon. Recently, minimally invasive surgical techniques would be able to accomplish the identical evaluation and treatment of this group of patients.Patients and Methods:A total of 40 patients (25 male, 15 female), age of 2-14 years, presented with symptoms of chronic abdominal pain, intermittent upper intestinal obstruction, recurrent bilious vomiting and failure to thrive. On clinical examination, none of the patients had signs of acute abdominal emergency. UGI contrast study was done and it was equivocal. All patients underwent laparoscopic evaluation.Results:A total of 36 patients (90%) were found on laparoscopy to have a discrepant finding of chronic intestinal malrotation. With narrow mesenteric base which put them at significant risk of midgut volvulus. Two patients (5%) were found to have chronic appendicitis with extensive adhesion at the right iliac fossa, one patient (2.5%) has annular pancreas and one patient has negative laparoscopic exploration. Laparoscopic findings of chronic intestinal malrotation includes, huge dilated stomach and the first part of duodenum, ectopic site of caecum central in the abdomen or under the liver, medial and low position of duodenojejunal junction, congested mesenteric veins with lymphatic oedema, generalised mesenteric lymphadenopathy, reversed relation of superior mesenteric artery and vein, right-sided small bowel.Conclusion:Laparoscopic diagnostic finding permits direct evaluation and treatment of undocumented malrotation in children, with equivocal UGI contrast study. Furthermore, laparoscopy provides an excellent opportunity to assess the base of the mesentery. Those children with a narrow base should undergo laparoscopic Ladd procedure to avoid catastrophic midgut volvulus.

A Case of Adult Intestinal Malrotation Diagnosed Preoperatively with Computed Tomography and Treated with a Laparoscopic Ladd Procedure

A Case of Adult Intestinal Malrotation Diagnosed Preoperatively with Computed Tomography and Treated with a Laparoscopic Ladd Procedure

Complete Intestinal Malrotation in Adult Associated to Intestinal Sub-Occlusion: Case Report

Intestinal malrotation is a congenital anomaly which includes all alterations that may occur in the rotation or fixation of the intestine during embryological development. Typically, it is evidenced in the first months of life, thus being a diagnostic challenge in symptomatic adults . The anomaly may remain asymptomatic or present a variety of symptoms, such as nausea, vomiting, diarrhea, abdominal pain and other dyspeptic symptoms. The treatment of choice is surgical and consists of the Ladd procedure. A case of intestinal malrotation was reported in a 49-year-old male patient, as well as a review of the literature on epidemiology, diagnosis and treatment.

Simultaneous laparoscopic repair of intestinal malrotation and ileal duplication

Abstract An 8-year old boy was referred for chronic, frequent bilious vomiting and intermittent abdominal pain. Intestinal malrotation was diagnosed by upper gastrointestinal study (UGI) and laparoscopic Ladd's procedure was performed. Ladd's bands were laparoscopically dissected out, and the mesentery was dissected to be broaden. After performing Ladd's procedure, an ileal duplication cyst was found 30 cm proximal to the terminal ileum, which was extracted through the umbilical port site and was totally resected. Three years postoperatively, the patient has had no further symptoms.

Malrotation with Isomerism: Laparoscopic Ladd Procedure

Introduction: Isomerism is a rare congenital condition in which one side of the body is a mirror image of the opposite side of the body. Abdominal manifestations include abnormal stomach positioning with possible malrotation of the intestines.1 If malrotation occurs, a laparoscopic Ladd procedure is performed. Materials and Methods: This video shows a laparoscopic Ladd procedure done in a 9-month-old male with right-sided isomerism and asymptomatic intestinal malrotation. Access to the right lower quadrant was achieved by a modified Hasson technique with a Step™ trocar (Auto-Suture) placed through a 5 mm incision in the umbilicus. Pneumoperitoneum was established using 5 L/minute of carbon dioxide under 12 mm Hg of pressure. A 30° telescope camera was inserted into the peritoneal cavity for proper observation. Next, two 3 mm incisions were made in the lower right and left abdominal quadrants. A 3 mm port was placed on the right and a 5 mm port was placed on the left with Step trocars (Auto-Suture). Important structures were immediately identified. The liver was located in the center of the abdomen and the spleen was absent, suggestive of right-sided isomerism. The attachment between the splenic flexure of the colon and the left lateral abdominal wall was divided. The colon was then reflected downwards, exposing the centrally located stomach. Duodenal loops were released from the Ladd bands, allowing for observation of the pancreas lying inside of the C-loop of the duodenum. While looking for the distal portion of the jejunum, it was discovered that the entire jejunum was trapped retroperitoneally, creating a mesocolic hernia. Using hook diathermy, the entire bowel was released down to the ileocecal region, which was in its normal anatomical location in the right lower quadrant. The appendix appeared normal. Using hook diathermy, the mesentery of the appendix was taken down. The appendix was ligated with two 3′0 Vicryl ties, resected, and removed through a port site. All of the small bowel was placed on the right side of the abdomen, and all of the large bowel was placed on the left. Finally, the stomach was insufflated to rule out an intrinsic duodenal obstruction. Air passed easily into the stomach and across the duodenum, confirming patency. The bowel appeared completely viable. Ports were withdrawn after desufflating the pneumoperitoneum. The umbilical port site was closed with 2-0 Vicryl UR-6 single suture. All other port sites were closed with Dermabond glue. Results and Conclusions: There were no postoperative complications. The patient began tolerating feeds on post-operative day #3 and was discharged on post-operative day #4. No competing financial interests exist. Runtime of video: 5 mins 51 secs

Abdominoplasty for Ladd’s procedure

Rotational anomalies occur when there is an abnormal arrest of rotation in the embryonic gut during development. The characteristic population affected is considered to be infants or young children, but in clinical practice, can be found in older children and adults as well. In these patients, the Ladd procedure is performed, whereby the abdomen is opened using traditional incisions, such as the midline laparotomy, for full visualization of the abdominal cavity. Despite providing excellent visualization, approaches such as this carry both increased surgical-site morbidity and an often-displeasing incision and visible scar. In this case report, we advocate consideration of the low transverse pfannenstiel incision and approach used traditionally in cosmetic and reconstructive abdominoplasty for surgical access to the abdomen for Ladd’s procedure. We believe that this alternative approach provides superior visualization without compromising the integrity or the esthetics of the abdominal wall in appropriate populations desiring to minimize the morbidity and visibility of their scar. Keywords: adult, adolescent, aesthetics, abdominoplasty, Ladd procedure, open

Preemptive Ladd Procedure in congenital diaphragmatic hernia and Abdominal Wall defects does not reduce the risk of future volvulus

IntroductionPatients with congenital diaphragmatic hernia (CDH), gastroschisis, and omphalocele are prone to abnormalities of intestinal rotation and thus future midgut volvulus. Controversy exists whether routine preemptive Ladd procedure in this subgroup of asymptomatic patients is of value to reduce future volvulus. MethodsThe Pediatric Health Information System (PHIS) database was queried for neonates with CDH, gastroschisis, and omphalocele between January 2009 and September 2015. Standard univariate and multivariate analysis was completed to compare risk of volvulus between patients treated with a preemptive Ladd versus no Ladd (p<0.05). ResultsSeven thousand seven hundred forty-nine neonates with CDH (40%), gastroschisis (38%), omphalocele (14%), and abdominal wall malformation (NOS) (9%) were identified. Overall, 3.6% (n=279) had a preemptive. Thirty-two patients had subsequent volvulus. Ladd procedure did not reduce volvulus readmissions for any diagnosis and was associated with a significantly increased risk of volvulus for omphalocele patients (9.1% vs 0.1%, p<0.001). Overall, a Ladd procedure during the index admission was associated with a higher risk for volvulus (1.4% vs. 0.4%, p=0.021) and was associated with a 3.28 increased odds ratio of future volvulus (95% CI 1.12–9.68). ConclusionLadd procedure performed prophylactically in patients with CDH, gastroschisis, and omphalocele did not reduce subsequent volvulus. Level of evidenceIII, Retrospective Comparative Study.

Laparascopic Ladd's procedure as treatment alternative, when parenteral or prolonged hospital nutrition is not an option for superior mesenteric artery syndrome

ObjectivesSuperior mesenteric artery syndrome (SMAS) is an uncommon cause of duodenal obstruction in pediatric patients. It is extremely rare in young infants. The classic treatment for SMAS has been an open or laparoscopic duodenojejunostomy when conservative medical therapy failed to resolve the obstruction. We herein reported 3 cases of SMAS in infants treated by laparoscopic Ladd's procedure. The advantages and feasibility of laparoscopic Ladd's procedure applied for SMAS in infants were discussed. MethodsThree cases of infants with SMAS subjected to laparoscopic Ladd's procedure in our hospital were collected from January 2014 to December 2015. The patients' age, operative time, postoperative hospital observation, resumption of full diet, and postoperative complications were analyzed. ResultsThe median age at operation was 8 months (range, 6–9 months). The mean body weight was 7.9 kg (range, 6.5–8.8 kg). The mean operative time was 66.7 min (range, 65–75 min). The mean postoperative hospital stay was 4.3 days (range, 4–5 days) and the follow-up was 20.7 months (range, 12–34 months) without any specific postoperative complications. ConclusionBased on our reports, laparoscopic Ladd's procedure is a reliable and practicable minimally invasive surgery for in infants with SMAS.

Congenital chylous ascites in infants: another presentation of intestinal malrotation

ObjectiveThe cause of the chylous ascites in infants isn't completely clear. The purpose of this study is to discuss our experience of recognition of intestinal malrotation as a cause of congenital chylous ascites in infants. MethodsMedical information of 10 infants with chylous ascites, who were admitted to the hospital between 2001 and 2014, was retrospective analyzed. Preoperatively, all patients underwent a period of conservative treatment. ResultsWe found that nine of ten patients with intestinal malrotation, six of them underwent laparoscopic Ladd's procedure and three patients underwent open Ladd's procedure. The remaining one patient suffered from mesenteric lymph nodes rupture and laparoscopic resection was performed. The cylous ascites subsided in all patients after the surgery and no significant recurrence was encountered during follow-up time. ConclusionsOur study demonstrates that congenital chylous ascites could be caused by intestinal malrotation, causing the obstruction of the lymphatic flow in the mesenteric lymphatic channels. Ladd's procedure maybe a safe and effective treatment for infantile intractable chylous ascites. Type of studyTreatment study. Level of evidenceLevel IV.

Advanced minimal access surgery in infants weighing less than 3 kg: A single center experience

BackgroundMinimal access surgery (MAS) has gained popularity in infants less than 5kg, however, significant challenges still arise in very low weight infants. Study designA retrospective chart review was performed to identify all infants weighing less than 3kg who underwent an advanced MAS or equivalent open procedure from 2009 to 2016. Advanced case types included Nissen fundoplication, duodenal atresia repair, Ladd procedure, congenital diaphragmatic hernia repair, esophageal atresia/tracheoesophageal fistula repair, diaphragmatic plication, and pyloric atresia repair. A comparative analysis was performed between the MAS and open cohorts. ResultsA total of 45 advanced MAS cases and 17 open cases met the inclusion criteria. Gestational age and age at operation were similar between the cohorts, while infants who underwent open procedures had significantly lower weight at operation (p=0.003). There were no deaths within 30days related to surgery in either group. Only 3 MAS cases required unintended conversion to open. There were 2 (4.4%) postoperative complications related to surgery in the MAS cohort and 2 (11.8%) in the open cohort. ConclusionAdvanced MAS may be performed in infants weighing less than 3kg with low mortality, acceptable rates of conversion, and similar rates of complications as open procedures. Type of studyPrognosis study. Level of evidenceLevel III.

A Case Study Examining the Current Evidence and Controversies in the Management of High-Risk Neonates With Malrotation

IntroductionHeterotaxy syndrome (HS) is a loss of the normal position of abdominal and thoracic organs and can be associated with severe cardiac disease and high mortality rates. Frequently associated intestinal malrotation further increases complications. Because of the high morbidity and mortality in this population, ongoing controversies exist regarding appropriate screening and management of these neonates. CaseA neonate born with HS and cardiac disease underwent complex cardiac surgery on first day of life. He is later found to have malrotation with midgut volvulus and undergoes Ladd procedure with intestinal detorsion. He subsequently presents with small bowel obstruction necessitating a second abdominal surgical intervention. ConclusionAlthough surgery is necessary here, this case demonstrates why current controversy exists regarding initial screening and subsequent offering of prophylactic Ladd procedure in asymptomatic neonates with HS because of the risk of challenging complications.

Total midgut volvulus in adults with intestinal malrotation. Report of eleven patients

Total small-intestinal volvulus with malrotation (TSIVM) classically presents in the neonatal period; it occurs much less frequently in the adult and is often misdiagnosed. Prognosis is directly related to the degree and duration of intestinal ischemia. Our goal is to describe our experience with TSIVM in the adult, to identify any specific findings and to discuss its management. Eleven patients who had undergone surgery for TSIVM at three centers between 1992 and 2012 were included. Surgery was performed as an emergency for five patients and surgery was elective for six. Mean follow-up was 63 months (range: 12-270). Six patients had had previous abdominal surgery. In nine cases, the diagnosis of TSIVM was made preoperatively, mainly by CT scan in eight cases. Seven patients had associated congenital failure of retroperitoneal fixation of the right colon and all of these underwent a Ladd procedure. The mortality rate was zero. Of the five patients who underwent emergency surgery, three required intestinal resections, one of whom developed a short bowel syndrome. The six patients who underwent surgery electively had no surgical complications. TSIVM is a very unusual finding in adult patients. The diagnosis can be made by CT scan with IV and oral contrast, but it often comes to light only at the time of surgery, even though the patients have often had recurrent episodes of abdominal symptomatology that dated back to childhood. The Ladd procedure, consisting of division of Ladd's bands, widening of the mesentery, and incidental appendectomy, remains the standard surgical repair. Digestive surgeons who care for adults should be familiar with this procedure, and it should be performed, as often as possible, with the assistance of a pediatric surgeon.

Intestinal malrotation needs immediate consideration and investigation.

The aim of this study was to evaluate clinical presentation, diagnostic studies, and volvulus rate and to describe the unusual clinical clues of intestinal malrotation. A retrospective descriptive review was carried out of all patients diagnosed with intestinal malrotation between 2002 and 2014. Patients were divided into two groups: infants (≤1year, n=16; group 1); and children (>1year, n=12; group 2). Patient demographics, clinical history, symptoms, physical examination, diagnostic work-up, operative findings and early outcome were evaluated. Bilious vomiting was the cardinal complaint in both groups. Unusual symptoms such as respiratory insufficiency, dehydration, afebrile convulsion, and lethargy were prominent symptoms in six patients in group 1, whereas history of frequent hospitalization due to recurrent abdominal pain and feeding intolerance were prominent in six patients in group 2. Midgut volvulus was identified in 15 patients, four of whom were in group 2. Standard Ladd's procedure was done in addition to correction of volvulus. Malrotation with or without midgut volvulus is not a rare condition and should be kept in mind for any age group. Specific signs of diagnosis are not easily identified. In the case of unusual clinical presentation, diagnosis may be delayed and can result in catastrophic consequences if intestinal perfusion occurs. Although midgut volvulus is seen most frequently in infants, risk and complication rate are high beyond 1year of age as well, and can manifest as failure to thrive, food intolerance, and abdominal pain needing recurrent hospitalization. Diagnostic suspicion and interdisciplinary coordination are essential for timely diagnosis and surgical treatment.

Comparing laparoscopic versus open Ladd's procedure in pediatric patients

Background/purposeThe objective of this study was to perform a comparative analysis of laparoscopic versus open Ladd's procedure on 30-day postoperative outcomes. MethodsAll elective Ladd's procedures performed on patients with intestinal malrotation in the 2013–2014 National Surgical Quality Improvement Program Pediatric were identified. A propensity score-matched analysis was used to account for baseline differences between groups, and generalized estimating equations (GEEs) were used to compare 30-day outcomes between open versus laparoscopic groups. ResultsFifty-eight (18.6%) patients underwent laparoscopic Ladd's while 253 (81.4%) underwent an open technique. After propensity score matching, 53 laparoscopic cases (38.1%) and 86 open cases (61.9%) were identified and compared for outcomes. Total length of stay was shorter for the laparoscopic group compared to the open group (6 vs. 4days, p<0.001). Postoperative length of stay was shorter for the laparoscopic group as well (5 vs. 4days, p<0.001). Postoperative complications occurred in 5 laparoscopic cases (9.4%) and in 18 open cases (20.9%), but did not meet statistical significance (p=0.08). One laparoscopic patient (1.9%) and 8 open patients (9.3%) required hospitalization beyond 30days, but this also did not meet significance (p=0.08). ConclusionsIn a matched analysis, laparoscopic Ladd's led to shorter hospital stays than open Ladd's in the initial 30-day postoperative period. Short-term benefits of laparoscopic Ladd's lend support for using additional resources to perform multi-institutional studies to compare differences in long-term outcomes between laparoscopic and open Ladd's. Type of studyTherapeutic Level of evidenceIII

The risk of midgut volvulus in patients with abdominal wall defects: A multi-institutional study

BackgroundThe management of malrotation in patients with congenital abdominal wall defects has varied among surgeons. We were interested in investigating the risk of midgut volvulus in patients with gastroschisis and omphalocele to help determine if these patients may benefit from undergoing a Ladd procedure. MethodsA retrospective chart review was performed for all patients managed at three institutions born between 1/1/2000 and 12/31/2008 with a diagnosis of gastroschisis or omphalocele. Patient charts were reviewed through 12/31/2012 for occurrence of midgut volvulus or need for second laparotomy. ResultsOf the 414 patients identified with abdominal wall defects, 299 patients (72%) had gastroschisis, and 115 patients (28%) had omphalocele. The mean gestational age at birth was 36.1±2.3weeks, and the mean birth weight was 2.57±0.7kg. There were a total of 8 (1.9%) cases of midgut volvulus: 3 (1.0%) patients with gastroschisis compared to 5 patients (4.4%) with omphalocele (p=0.04). ConclusionsPatients with omphalocele have a greater risk of developing midgut volvulus, and a Ladd procedure should be considered during definitive repair to mitigate these risks. Level of evidenceIII; retrospective comparative study