Abstract
Purpose Intestinal malrotation is a congenital intestinal rotation anomaly, which can be
treated by either laparotomy or laparoscopy. Our hypothesis is that laparoscopic treatment
leads to less small bowel obstruction because of the fewer adhesions in comparison
to laparotomy, without increasing the risk of recurrent volvulus. We analyzed the
outcome of patients who had a correction for intestinal malrotation after the introduction
of laparoscopy.
Methods All patients between 0 and 18 years who underwent a surgical procedure for malrotation
in the Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands, between January
2004 and December 2011 were retrospectively reviewed for duration of operation, perioperative
complications, length of hospital stay, and rate of redo surgery for intestinal volvulus
or obstruction.
Results A total of 83 patients were included of which 33 had a laparoscopic procedure and
50 had a laparotomy for suspected malrotation. Operating time was 63 minutes for the
laparoscopic procedure versus 76 minutes for laparotomy (p = 0.588). Significantly more complications were found in the laparotomy group (11
vs. 35%, p = 0.047). However, one patient (aged 4 months) in the laparoscopy group developed
an early (< 24 hours) recurrent volvulus. Length of hospital stay was significantly
longer after a laparotomy (9 vs. 16 days, p = 0.002). Three (17%) patients in the laparoscopy group needed redo surgery compared
with six (9%) in the laparotomy group (p = 0.400). No late volvulus occurred in both groups. After laparotomy, redo surgery
because of the small bowel obstruction was more frequent (5 vs. 0%), although this
was not statistically significant.
Conclusion In both the laparoscopy and laparotomy group, no cases of long-term recurrent volvulus
were seen. After laparotomy, more patients developed a late small bowel obstruction
because of the adhesions for which redo surgery was needed. In the laparotomy group,
the number of complications was significantly higher and the length of hospital stay
was significantly longer. Comparing laparoscopy and laparotomy for the treatment of
malrotation, no difference exists for the long-term risk of recurrent volvulus. In
children aged 6 months or older with suspicion of intestinal malrotation but not presenting
with an acute abdomen or hemodynamically instability, laparoscopy should be considered
as a first approach to diagnose and subsequently treat intestinal malrotation.
Keywords
malrotation - laparoscopy - Ladd procedure - redo surgery - volvulus
