Department of Paediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
J Pediatr Surg. 2011 Feb;46(2):289-91. doi: 10.1016/j.jpedsurg.2010.11.005.
Children being investigated for gastroesophageal reflux (GOR) have a high incidence of malrotation. Current literature suggests these patients should be managed with a combined antireflux and Ladd's procedure. We review our experience, the largest series to date, of performing an elective Ladd's procedure as the first-line intervention.
Retrospective case note review of 20 children with significant symptoms of GOR and an incidental finding of malrotation. Children presenting immediately with bilious vomiting were excluded. All patients underwent a Ladd's procedure as their sole primary operative intervention.
Median age at operation was 7 months (21 days-12 years). Fifteen patients (75%) had evidence of reflux on barium contrast study. All children were followed up for at least 6 months. Eighteen (90%) had resolution or significant improvement of their symptoms postsurgery. Only 3 have not managed to tolerate a full oral diet, all unrelated to GOR. None of our series required an antireflux procedure.
In children with debilitating vomiting necessitating surgical management, a contrast study is imperative in the work up. The high incidence of GOR and the significant improvement after correction of malrotation show the relationship between delayed gastric emptying and GOR. We suggest that when an abnormally placed duodenojejunal flexure is found, a Ladd's procedure alone is sufficient and may obviate the need for a more invasive antireflux procedure.
患有胃食管反流（GOR）的儿童中，肠旋转不良的发生率很高。目前的文献表明，这些患者应采用抗反流和 Ladd 手术联合治疗。我们回顾了我们的经验，这是迄今为止最大的系列，即作为一线干预措施进行择期 Ladd 手术。
回顾性病例记录了 20 例有明显 GOR 症状和偶然发现肠旋转不良的儿童。立即出现胆汁性呕吐的患儿被排除在外。所有患儿均接受 Ladd 手术作为其唯一的一线手术干预。
手术时的中位年龄为 7 个月（21 天至 12 岁）。15 例（75%）患儿在钡剂造影研究中存在反流证据。所有患儿均至少随访 6 个月。18 例（90%）患儿术后症状缓解或明显改善。仅有 3 例未能完全耐受口服饮食，均与 GOR 无关。我们的系列中均无需进行抗反流手术。
对于需要手术治疗的有严重呕吐的儿童，在检查中进行对比研究至关重要。GOR 的高发生率和肠旋转不良纠正后的显著改善表明胃排空延迟与 GOR 之间存在关系。我们建议，当发现十二指肠空肠曲位置异常时，单独进行 Ladd 手术就足够了，可能无需进行更具侵入性的抗反流手术。
