Journal of pediatric surgery · 2025
Risk Factors for Postoperative Volvulus and its Laparoscopic Management Following Laparoscopic Ladd's Procedure in Pediatric Patients With Intestinal Malrotation: A Single-center, Retrospective Cohort Study.
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Duy Hien Pham, Manh Hoan Vu, Tran Nam Xuan, Yoshimura Shohei, Okata Yuichi
Аннотация
INTRODUCTION: Laparoscopic Ladd's procedure (LL) for intestinal malrotation remains controversial, owing to a higher postoperative volvulus rate than that associated with open management. We aimed to identify risk factors for postoperative volvulus after LL in pediatric patients with intestinal malrotation and evaluate the outcomes of redo LL in recurrent cases.
MATERIALS AND METHODS: This single-center, retrospective cohort study included pediatric patients aged <16 years who underwent LL for intestinal malrotation at Vietnam National Children's Hospital from April 2017 to March 2023. Open conversion cases were excluded. All eligible patients were divided into two groups: those with and without postoperative volvulus during follow-up after initial LL. The risk factors for postoperative volvulus were explored using Cox proportional hazards models.
RESULTS: A total of 126 patients underwent LL, of whom 5 (4.0 %) who required open conversion were excluded. Finally, 121 cases (87 boys and 34 girls) with median age at surgery of 11 days [2-4380 days] were enrolled. Postoperative volvulus developed in 13/121 (10.7 %) patients, and the median time from primary LL to redo LL was 64 days [16-181 days]. Redo LL with cecopexy was successful without complications in 12/13 patients. Multivariate Cox proportional hazards models revealed operative age >30 days as an independent risk factor for postoperative volvulus (adjusted hazard ratio 3.66, 95 % confidence interval 1.21-11.0, p = 0.021).
CONCLUSION: Operative age >30 days is an independent risk factor for postoperative volvulus following LL in pediatric patients with intestinal malrotation. The addition of cecopexy during LL can reduce the risk of postoperative volvulus.
LEVEL OF EVIDENCE: III.
MATERIALS AND METHODS: This single-center, retrospective cohort study included pediatric patients aged <16 years who underwent LL for intestinal malrotation at Vietnam National Children's Hospital from April 2017 to March 2023. Open conversion cases were excluded. All eligible patients were divided into two groups: those with and without postoperative volvulus during follow-up after initial LL. The risk factors for postoperative volvulus were explored using Cox proportional hazards models.
RESULTS: A total of 126 patients underwent LL, of whom 5 (4.0 %) who required open conversion were excluded. Finally, 121 cases (87 boys and 34 girls) with median age at surgery of 11 days [2-4380 days] were enrolled. Postoperative volvulus developed in 13/121 (10.7 %) patients, and the median time from primary LL to redo LL was 64 days [16-181 days]. Redo LL with cecopexy was successful without complications in 12/13 patients. Multivariate Cox proportional hazards models revealed operative age >30 days as an independent risk factor for postoperative volvulus (adjusted hazard ratio 3.66, 95 % confidence interval 1.21-11.0, p = 0.021).
CONCLUSION: Operative age >30 days is an independent risk factor for postoperative volvulus following LL in pediatric patients with intestinal malrotation. The addition of cecopexy during LL can reduce the risk of postoperative volvulus.
LEVEL OF EVIDENCE: III.