LAPAROSCOPIC LADD PROCEDURE IN INFANTS WITH MALROTATION

Purpose: This clinical study was undertaken to examine the feasibility of a laparoscopic approach for the treatment of documented malrotatio n. Methods: From May 1994 through January of 1997, 12 patients, aged 5 days to 4 months, weighing 3 to 7 kg, underwent laparoscopic Ladd's p rocedure for malrotation, All patients had symptoms of intermittent up per intestinal obstruction, and malrotation was documented by an upper gastrointestinal contrast study. None of the patients had acute volvu lus or compromised bowel. The procedure was performed using 3 trocars of 3.5 mm diameter. Ports were placed in the infraumbilical ring, and the right and left mid to lower quadrants. A standard Ladd's procedure with appendectomy was performed in all cases. Results: All procedures were completed successfully through the laparoscope. Operative times averaged 58 minutes (35 to 120 minutes). One patient with Pierre-Robin underwent a laparoscopic Nissen fundoplication and gastrostomy tube p lacement at the same time requiring 120 minutes. Feedings were started on postoperative day (POD) 1 in 10 cases and POD 2 in two cases. Hosp ital stay ranged from 2 to 4 days (average, 2.2) in the patients with isolated malrotation, The patient with Pierre-Robin had a prolonged ho spitalization because of chronic respiratory problems not associated w ith surgery. There were no complications. All patients had resolution of their symptoms. Conclusions: Laparoscopic Ladd's procedure is a saf e and effective technique. It can be performed in neonates in times eq uivalent to standard open techniques, and it appears to allow for earl ier feeds and decreased hospital stays. Copyright (C) 1998 by W.B. Sau nders Company.