Conditions required for laparoscopic repair of subacute volvulus of the midgut in neonates with intestinal malrotation: 5 cases.
BACKGROUND
This study aimed to evaluate the optimal conditions for laparoscopic management of neonatal subacute volvulus with malrotation.


METHODS
Between 1994 and 2002, 13 neonates with midgut volvulus and malrotation entered the authors' institution. Five of these neonates met the eligibility criteria for laparoscopy: good hemodynamic parameters, no gut perforation, and no severe ischemic distress of the bowel shown on preoperative ultrasonography.


RESULTS
The results were excellent for only three infants, associated with a shorter postoperative course. One underwent reoperation for a residual duodenal band, and one conversion to open laparotomy was necessary. The predictors of success were no difficulty identifying the abnormal anatomy, no important chylous stasis, and the learning curve of the surgeon.


CONCLUSIONS
Despite its previously reported feasibility, neonatal laparoscopy for volvulus with intestinal malrotation is appropriate only for a small number of patients. Strict selection criteria with a clear understanding of the optimal conditions for success may improve the outcome.
Kalfa
N
N
Department of Visceral Pediatric Surgery, Lapeyronie Hospital, 371 Av Doyen Gaston Giraud, 34295, Montpellier, Cedex 5, France.
Zamfir
C
C
Lopez
M
M
Forgues
D
D
Raux
O
O
Guibal
M P
MP
Galifer
R B
RB
Allal
H
H
D000208:Acute Disease; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D045822:Intestinal Volvulus / Q000209:etiology* / Q000601:surgery*; D007422:Intestines / Q000002:abnormalities*; D010535:Laparoscopy / Q000592:standards*; D012307:Risk Factors