What is the role of laparoscopy in the treatment of intestinal malrotation?

Updated: Dec 19, 2018
  • Author: Denis D Bensard, MD, FACS, FAAP; Chief Editor: Carmen Cuffari, MD  more...
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Answer

Use of a laparoscopic approach to the correction of malrotation is feasible (level III, level IV evidence) but long-term outcome data is lacking. An open approach is thought to create adhesions, thereby reducing the risk of recurrent volvulus. Critics of the laparoscopic approach cite that laparoscopy is associated with minimal adhesion formation and inadequate widening of the mesentery and thus may not afford the patient comparable long-term benefit. [39, 40, 41]

Laparoscopy has been used to repair malrotation in clinically stable patients with or without signs of duodenal obstruction without midgut volvulus.

The Ladd procedure, including widening of the mesenteric base and dissection of peritoneal bands, has been performed successfully using a laparoscopic approach and has resulted in shorter hospital length of stay.

Laparoscopic Ladd procedure is now accepted as an initial approach to surgical correction, with recent reports showing superior short-term results including shorter term to full diet without any increase in operative duration. [42, 43, 44, 45]

Some authors have reported on the success of single-incision laparoscopic Ladd procedure for intestinal malrotation without volvulus in adults. [46]

A study reported that 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. [47]


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