Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China.
BMC Gastroenterol. 2023 Nov 20;23(1):402. doi: 10.1186/s12876-023-03046-1.
The objective of this study was to evaluate the safety and efficacy of laparoscopic Ladd's procedure (LL) for intestinal malrotation (IM) in small infants.
All patients aged < 6 months with IM who underwent Ladd's procedures between January 2012 and December 2019 were enrolled. The perioperative demographics and midterm follow-up results were retrospectively reviewed and compared between patients who underwent LL and open Ladd's operation (OL).
Fifty-five patients were enrolled for analysis. The baseline characteristics were well matched in the two groups. The rate of volvulus was similar in the two groups (76.2% vs. 73.5%, P = 0.81). Two cases in the LL group were converted to OL due to intraoperative bleeding and intestinal swelling. The operative time (ORT) was not significantly different between the two groups (73.8 ± 18.7 vs. 66.8 ± 11.6 min, P = 0.76). Compared to the OL group, the LL group had a shorter time full feed (TFF) (3.1 ± 1.2 vs. 7.3 ± 1.9 days, P = 0.03) and a shorter postoperative hospital stay (PHS) than the OL group (5.5 ± 1.6 vs. 11.3 ± 2.7 days, P = 0.02). The rate of postoperative complications was similar in the two groups (9.5% vs. 11.8%, P = 0.47). The LL group had a lower rate of adhesive obstruction than the OL group, but the difference was not significant (0.0% vs. 11.8%, P = 0.09). One patient suffered recurrence in the LL group, while 0 patients suffered recurrence in the OL group (4.8% vs. 0.0%, P = 0.07). The rate of reoperation in the two groups was similar (4.8% vs. 8.8%).
The LL procedure for IM in small infants was a safe and reliable method that had a satisfactory cosmetic appearance and shorter TFF and PHS than OL.
本研究旨在评估腹腔镜 Ladd 手术（LL）治疗小婴儿肠旋转不良（IM）的安全性和有效性。
回顾性分析 2012 年 1 月至 2019 年 12 月期间接受 Ladd 手术的年龄<6 个月的 IM 患者。比较 LL 组和开放 Ladd 手术（OL）组患者的围手术期人口统计学和中期随访结果。
55 例患者纳入分析。两组患者的基线特征无明显差异。两组肠扭转发生率相似（76.2% vs. 73.5%，P=0.81）。LL 组有 2 例因术中出血和肠肿胀而转为 OL。两组手术时间（ORT）无显著差异（73.8±18.7 vs. 66.8±11.6 min，P=0.76）。与 OL 组相比，LL 组完全喂养时间（TFF）更短（3.1±1.2 vs. 7.3±1.9 天，P=0.03），术后住院时间（PHS）更短（5.5±1.6 vs. 11.3±2.7 天，P=0.02）。两组术后并发症发生率相似（9.5% vs. 11.8%，P=0.47）。LL 组粘连性梗阻发生率低于 OL 组，但差异无统计学意义（0.0% vs. 11.8%，P=0.09）。LL 组 1 例复发，OL 组无复发（4.8% vs. 0.0%，P=0.07）。两组再次手术率相似（4.8% vs. 8.8%）。
LL 治疗小婴儿 IM 是一种安全可靠的方法，与 OL 相比，具有良好的美容效果，TFF 和 PHS 更短。
