Prophylactic appendectomy during Ladd's procedure: a multicenter survey of institutional approaches and their rationales in Japan.

PURPOSE: To describe institutional approaches to prophylactic appendectomy during Ladd's procedure in Japan, including rationales and prespecified exceptions.

METHODS

We conducted a cross-sectional questionnaire survey through the Japanese Society of Pediatric Surgeons Under-45 Working Group. Member institutions reported their usual institutional approach in a standardized index scenario of emergency Ladd's procedure for midgut volvulus in a stable term neonate without intestinal necrosis or perforation. Responses were analyzed descriptively.

RESULTS

Forty-six of 50 invited institutions responded; 45 with a unified institutional approach were analyzed. In the index scenario, 22 institutions (48.9%) reported routinely performing prophylactic appendectomy and 23 (51.1%) reported not performing it. Performance institutions most commonly cited avoidance of future diagnostic confusion (72.7%) and prevention of future appendicitis (68.2%), whereas non-performance institutions emphasized confidence in contemporary imaging (60.9%) and avoidance of unnecessary procedures or complications (47.8%). Among performance institutions, omission was mainly reported in the presence of intestinal necrosis, perforation, or very or extremely low birthweight; deviations from non-performance were rare.

CONCLUSION

Japanese institutions show highly standardized yet divergent approaches to prophylactic appendectomy during Ladd's procedure. These findings clarify how diagnostic, operative, and future reconstructive considerations are balanced and provide a practical framework for protocol review and outcome-focused studies.