Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE.
Mediclinic Parkview Hospital, Dubai, UAE.
Pediatr Surg Int. 2023 Apr 3;39(1):164. doi: 10.1007/s00383-023-05437-7.
Ladd's Procedure has been the surgical intervention of choice in the management of congenital intestinal malrotation for the past century. Historically, the procedure included performing an appendectomy to prevent future misdiagnosis of appendicitis, since the location of the appendix will be shifted to the left side of the abdomen. This study consists of two parts. A review of the available literature on appendectomy as part of Ladd's procedure and then a survey sent to pediatric surgeons about their approach (to remove the appendix or not) while performing a Ladd's procedure and the clinical reasoning behind their approach.
The study consists of 2 parts: (1) a systematic review was performed to extract articles that fulfill the inclusion criteria; (2) a short online survey was designed and sent by email to 168 pediatric surgeons. The questions in the survey were centered on whether a surgeon performs an appendectomy as part of the Ladd's procedure or not, as well as their reasoning behind either choice.
The literature search yielded five articles, the data from the available literature are inconsistent with performing appendectomy as part of Ladd's procedure. The challenge of leaving the appendix in place has been briefly described with minimal to no focus on the clinical reasoning. The survey demonstrated that 102 responses were received (60% response rate). Ninety pediatric surgeons stated performing an appendectomy as part of the procedure (88%). Only 12% of pediatric surgeons are not performing appendectomy during Ladd's procedure.
It is difficult to implement a modification in a successful procedure like Ladd's procedure. The majority of pediatric surgeons perform an appendectomy as part of its original description. This study has identified gaps in the literature pertaining to analyze the outcomes of performing Ladd's procedure without an appendectomy which should be explored in future research.
在过去的一个世纪里，Ladd 手术一直是治疗先天性肠旋转不良的首选手术干预方法。从历史上看，该手术包括进行阑尾切除术，以防止未来误诊阑尾炎，因为阑尾的位置会转移到腹部左侧。本研究包括两部分。一部分是对 Ladd 手术中阑尾切除术的相关文献进行综述，另一部分是对小儿外科医生进行的问卷调查，内容是他们在进行 Ladd 手术时是否切除阑尾以及他们选择的依据。
本研究包括两部分：（1）进行系统评价，以提取符合纳入标准的文章；（2）设计并通过电子邮件向 168 名小儿外科医生发送了一份简短的在线调查。调查中的问题集中在外科医生是否将阑尾切除术作为 Ladd 手术的一部分，以及他们选择的理由。
文献检索共获得 5 篇文章，现有文献中的数据与将阑尾切除术作为 Ladd 手术的一部分不一致。将阑尾留在原处的挑战只是简要描述，几乎没有关注临床推理。调查显示，共收到 102 份回复（60%的回复率）。90 名小儿外科医生表示将阑尾切除术作为该手术的一部分（88%）。只有 12%的小儿外科医生在进行 Ladd 手术时不切除阑尾。
在像 Ladd 手术这样成功的手术中很难进行修改。大多数小儿外科医生按照原始描述进行阑尾切除术。本研究发现，在文献中存在与不进行阑尾切除术的 Ladd 手术相关的结果分析的空白，这应该在未来的研究中进行探讨。
