9762 Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK.
42487 Division of Pediatric Surgery, Department of Pediatrics, Regional University Hospital of Maringá, State University of Maringá, Maringá, Brazil.
Am Surg. 2021 Feb;87(2):253-258. doi: 10.1177/0003134820951424. Epub 2020 Sep 15.
Laparoscopic approach for malrotation has become more popular for neonates and in cases with volvulus, but its safety and efficacy remains controversial. This study reviewed laparoscopy outcomes in neonate/infant malrotation.
Medline/PubMed and Lilacs databases were reviewed. Data from studies published in English/Spanish between 1995 and 2019 were collected. Results are presented as percentages and means/medians; logistic regression was used to study possible associations.
Nineteen papers offered 99 neonates/infants with median age and weight of 10.5 days and 3.5 kg, respectively. Ladd's procedure was performed in 95 (96%) patients and bands' division in 4 (4%); appendectomy was not included in 16 (16.2%) patients, and cecopexy was not performed in all cases. Volvulus was reported in 39 (39.4%) patients. There were 11 conversions (11.1%) and 10 recurrences of symptoms (10.1%) that required reintervention. An association was found between volvulus and recurrence ( = .05) and the need for conversion ( < .01). There were 10 (10.1%) minor complications and no mortality. The median follow-up was 10 months.
Laparoscopic approach to malrotation is feasible and safe in hemodynamically stable neonates/infants without intestinal necrosis and is associated with 11% conversion rate and 10% reinterventions. The presence of volvulus is associated with recurrence and conversion. Laparoscopic Ladd's procedure with appendectomy and without cecopexy is the commonly practiced approach that is associated with minor complications.
腹腔镜手术在新生儿和扭转病例中越来越受欢迎，但它的安全性和有效性仍存在争议。本研究回顾了新生儿/婴儿旋转不良的腹腔镜手术结果。
检索 Medline/PubMed 和 Lilacs 数据库。收集了 1995 年至 2019 年期间以英语/西班牙语发表的研究数据。结果以百分比和平均值/中位数表示；使用逻辑回归研究可能的关联。
19 篇论文提供了 99 例新生儿/婴儿的数据，中位数年龄和体重分别为 10.5 天和 3.5 公斤。95 例（96%）患者行 Ladd 手术，4 例（4%）行带分割术；16 例（16.2%）患者未行阑尾切除术，所有病例均未行盲肠固定术。39 例（39.4%）患者有扭转。有 11 例（11.1%）转为开腹手术，10 例（10.1%）症状复发需要再次干预。扭转与复发（ =.05）和需要转为开腹手术（ <.01）之间存在关联。有 10 例（10.1%）出现轻微并发症，无死亡病例。中位随访时间为 10 个月。
在没有肠坏死的情况下，腹腔镜手术治疗血流动力学稳定的新生儿/婴儿是可行和安全的，其转化率为 11%，再次干预率为 10%。存在扭转与复发和转化有关。伴有阑尾切除术且不进行盲肠固定术的腹腔镜 Ladd 手术是常见的手术方法，其相关并发症轻微。
