Department of Pediatric Surgery, Vietnam National Children's Hospital, Hanoi, Vietnam.
Division of Pediatric Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Pediatr Int. 2020 Jul;62(7):828-833. doi: 10.1111/ped.14194. Epub 2020 Jun 10.
The aim of this study was to assess the efficacy of our simple landmark technique for laparoscopic detorsion and the Ladd's procedure (lap-Ladd) for malrotation with midgut volvulus in neonates and to identify the risk factors for reoperation after the lap-Ladd.
We conducted a retrospective chart review of 42 patients after lap-Ladd for malrotation between April 2017 and June 2019. Information regarding patient status and intraoperative and postoperative data were analyzed.
Thirty-one patients had volvulus (73.8 %), while 11 patients did not (26.2%). The median age and weight between the two groups at operation were 9 days (range, 3-28 days), 3.2 kg (range, 2-8 kg) and 6 days (range, 2-11), 2.9 kg (range, 2-3.8 kg), respectively. The operative time was significantly shorter in patients with volvulus compared to those without (60 vs 105 min, P = 0.002). Two cases were converted to open surgery because of ischemic changes of the total small intestine during surgery. Reoperation was required in two patients with volvulus (due to adhesive small bowel obstruction and recurrent volvulus). There was no significant predictive factor for reoperation after the lap-Ladd procedure.
Our simple landmark lap-Ladd procedure demonstrated feasibility and good short-term outcomes in neonates with malrotation, regardless of the presence or absence of volvulus.
本研究旨在评估我们用于腹腔镜松解和 Ladd 手术（lap-Ladd）治疗新生儿肠旋转不良合并中肠扭转的简单标志技术的疗效，并确定 lap-Ladd 术后再次手术的危险因素。
我们对 2017 年 4 月至 2019 年 6 月期间接受 lap-Ladd 治疗的 42 例肠旋转不良患儿进行了回顾性图表分析。分析了患者的状态以及术中、术后数据。
31 例有扭转（73.8%），11 例无扭转（26.2%）。两组患儿手术时的中位年龄和体重分别为 9 天（3-28 天）、3.2 公斤（2-8 公斤）和 6 天（2-11 天）、2.9 公斤（2-3.8 公斤）。有扭转的患儿手术时间明显短于无扭转的患儿（60 分钟比 105 分钟，P=0.002）。2 例因术中总小肠缺血改变而转为开放手术。2 例有扭转的患儿需要再次手术（因粘连性小肠梗阻和再次扭转）。lap-Ladd 术后再次手术无明显预测因素。
我们的简单标志 lap-Ladd 手术在有无扭转的新生儿肠旋转不良中具有可行性和良好的短期效果。
