Malrotation: the postoperative period.
OBJECTIVE
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 seems to be delayed.


METHODS
Postoperative return of bowel function after performance of a Ladd's procedure was studied retrospectively in a series of 57 children treated between 1981 and 1994. Excluded were those patients who had a malrotation in combination with an abdominal wall defect, a congenital diaphragmatic hernia, or duodenal atresia. Patients were divided in two groups; one group consisted of patients less than 1 year of age and one group of those 1 year of age and older.


RESULTS
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 postoperatively. Gastric tube decompression was necessary for 8.6 days (n = 15) compared with only 5.1 days (n = 45) for the group without a volvulus (P = .003, analysis by t test).


CONCLUSIONS
The authors recommend that a central venous line be inserted for feeding purposes when a volvulus is present at operation.
Feitz
R
R
The Pediatric Surgical Center Amsterdam, Department of Pediatric Surgery, Academic Hospital of the Free University of Amsterdam, and Emmakinderziekenhuis/Kinder AMC, The Netherlands.
Vos
A
A
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003289:Convalescence; D004322:Drainage; D005260:Female; D005769:Gastrointestinal Motility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D007422:Intestines / Q000002:abnormalities* / Q000601:surgery*; D007441:Intubation, Gastrointestinal; D008297:Male; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D014102:Torsion Abnormality