MALROTATION - THE POSTOPERATIVE PERIOD

Background/Purpose: There have been many reports of patients who have persistent gastrointestinal symptoms after undergoing Ladd's procedure . Postoperative return of bowel function in many of these patients see ms to be delayed. Methods: Postoperative return of bower function afte r performance of a Ladd's procedure was studied retrospectively in a s eries of 57 children treated between 1981 and 1994. Excluded were thos e patients who had a malrotation in combination with an abdominal wall defect, a congenital diaphragmatic hernia, or duodenal atresia. Patie nts were divided in two groups; one group consisted of patients less t han 1 year of age and one group of those 1 year of age and older. Resu lts: Nasogastric tube decompression was necessary for an average of 6. 7 days in the first group and 4.3 days in the older children (P = .03) . A midgut volvulus delays resumption of bowel function postoperativel y. Gastric tube decompression was necessary for 8.6 days (n = 15) comp ared with only 5.1 days (n = 45) for the group without a volvulus (P = .003, analysis by t test). Conclusion: The authors recommend that a c entral venous line be inserted for feeding purposes when a volvulus is present at operation. Copyright (C) 1997 by W.B. Saunders Company.