The surgical management of malrotation: A Canadian Association of Pediatric Surgeons survey.

PURPOSE: Some surgeries are now performed almost exclusively via a laparoscopic approach to enhance recovery and reduce postoperative complications. This survey explored institutional and individual physician practice patterns of the surgical management of malrotation.

METHODS

All 2015 Canadian Association of Pediatric Surgeons annual meeting attendees were invited to complete an anonymous prepiloted survey. Descriptive statistics were calculated.

RESULTS

The response rate was 35% (150 distributed, 52 returned). Most institutions (39.5%) saw on average 5-10 cases of malrotation per year. Most respondents (54.2%) indicated that the laparoscopic (LL) and open Ladd's (OL) procedures were equal surgical approaches for stable patients. Respondents were nearly equally divided (47.9% yes; 44.7% no) with respect to whether an LL procedure led to a higher risk of postoperative volvulus. Of those who answered yes, most indicated that an increased risk of postoperative volvulus was because of an inadequate widening of mesentery (45.8%), reduced "beneficial" postoperative adhesions (29.2%), or both (16.7%). 100% of respondents who perform an OL as their standard procedure indicated that there was a higher risk of postoperative volvulus with LL procedure. Only 1/8 who performed a LL as a standard approach routinely performed an appendectomy.

CONCLUSION

There remain polarized views on the best surgical approach to malrotation yet a persistent belief in the reduction in postoperative adhesions in leading to a postoperative volvulus with LL procedures. Collaboration to permit long-term follow-up of a large cohort may help develop guidelines for the operative management of malrotation.

LEVEL OF EVIDENCE: Level V.