SIMULTANEOUS CORRECTION OF MALROTATION AND GASTROESOPHAGEAL REFLUX ININFANTS

Gastroesophageal reflux (GER) is often associated with gastrointestina l malrotation in infants. Primary correction of the malrotation, reser ving a secondary antireflux procedure for those patients with persiste nt symptoms of GER, is most commonly practiced. This decision is based on the notion that an antireflux procedure may be unnecessary and is associated with added morbidity. We retrospectively reviewed 12 infant s with GER and malrotation. All infants had symptoms attributed to GER and/or malrotation. A control group of seven infants with malrotation only was included for comparison of operative duration and postoperat ive recovery. Infants who received concurrent Ladd and Nissen procedur es (Group 1, n = 8) had immediate resolution of symptoms. Infants trea ted by Ladd procedure alone (Group 2, n = 4), had persistent symptoms, despite postoperative medical therapy. A subsequent antireflux proced ure was necessary. Comparison of operative times showed that a simulta neous procedure added, on average, 35 minutes to the Ladd procedure. P ostoperative feeding and hospital stay were comparable between Group 1 and the control group. In contrast, Group 2 patients had longer hospi talizations due to ineffective medical therapy for persistent GER. No significant morbidity was noted. We recommend comprehensive surgical t reatment with concurrent Ladd and Nissen procedures. This approach pro vides expedient and effective treatment of GER and malrotation, with m inimal increase in operative time and no increase in morbidity.