title: Laparoscopic versus open Ladd's procedure for intestinal malrotation in adults.
abstract: BACKGROUND
  Intestinal malrotation results from errors in fetal intestinal rotation and fixation. While most patients are diagnosed in childhood, some present as adults. Laparoscopic Ladd's procedure is an accepted alternative to laparotomy in children but has not been well-studied in adults. This study was designed to investigate outcomes for adults undergoing laparoscopic Ladd's repair for malrotation.
  
  
  METHODS
  We performed a single-institution retrospective chart review over 11 years. Data collected included patient age, details of pre-operative work-up and diagnosis, surgical management, complications, rates of re-operation, and symptom resolution. Patients were evaluated on an intent-to-treat basis based on their planned operative approach. Categorical data were analyzed using Fisher's exact test. Continuous data were analyzed using Student's t test.
  
  
  RESULTS
  Twenty-two patients were identified (age range 18-63). Fifteen were diagnosed pre-operatively; of the remaining seven patients, four received an intra-operative malrotation diagnosis during elective surgery for another problem. Most had some type of pre-operative imaging, with computed tomography being the most common (77.3 %). Comparing patients on an intent-to-treat basis, the two groups were similar with respect to age, operative time, and estimated blood loss. Six patients underwent successful laparoscopic repair; three began laparoscopically but were converted to laparotomy. There was a statistically significant difference in hospital length of stay (LOS) (5.0 ± 2.5 days vs 11.6 ± 8.1 days, p = 0.0148) favoring the laparoscopic approach. Three patients required re-operation: two underwent side-to-side duodeno-duodenostomy and one underwent a re-do Ladd's procedure. Ultimately, three (two laparoscopic, one open) had persistent symptoms of bloating (n = 2), constipation (n = 2), and/or pain (n = 1).
  
  
  CONCLUSIONS
  Laparoscopic repair appears to be safe and effective in adults. While a small sample size limits the power of this study, we found a statistically significant decrease in LOS and a trend toward decreased postoperative nasogastric decompression. There were no significant differences in complication rates, re-operation, or persistence of symptoms between groups.
authors.affiliation: Department of Surgery, University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792-3284, USA, lfrasier@uwhealth.org.
authors.forename: Lane L
authors.initials: LL
authors.lastname: Frasier
authors.forename: Glen
authors.initials: G
authors.lastname: Leverson
authors.forename: Ankush
authors.initials: A
authors.lastname: Gosain
authors.forename: Jacob
authors.initials: J
authors.lastname: Greenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D004385:Duodenostomy; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D045822:Intestinal Volvulus / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult