title: Heterotaxy syndrome and intestinal rotational anomalies: Impact of the Ladd procedure.
abstract: BACKGROUND
  Children with heterotaxy syndrome and intestinal rotational anomalies (IRA) are at risk for midgut volvulus and ischemia. Controversy exists regarding risks and benefits of prophylactic Ladd procedures. The purpose of this study is to assess the impact of Ladd procedures on adverse events for children with heterotaxy and IRA.
  
  
  METHODS
  A retrospective cohort study using the Pediatric Health Information System (PHIS) database was performed. All children with heterotaxy and IRA admitted at age ≤ 30 days and discharged between 1/1/2004 and 1/1/2011 were included with a minimum 2-year follow-up period. The primary outcome was major morbidity, defined as a composite variable for intestinal obstruction/volvulus, ischemia, or resection, or inhospital mortality. Univariable and multivariable analyses were performed.
  
  
  RESULTS
  There were 325 patients who met the inclusion criteria, including 92 (28%) patients with single ventricles. Mean gestational age was 38.0 ± 2.1 weeks and birth weight was 3.1 ± 0.6 kg. Ladd procedure was performed during initial hospitalization on 188 (58%) children. In multivariable analyses, Ladd procedure on initial hospitalization was associated with a 2.2 times increased odds of adverse events on subsequent admissions (95% CI 1.3-4.0, p = 0.007).
  
  
  CONCLUSIONS
  Ladd procedure is associated with increased odds of adverse events for children with heterotaxy and IRA.
authors.affiliation: Department of Pediatrics, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, 630W 168th St.-VC 507, New York, NY 10032, USA. Electronic address: ars9044@nyp.org.
authors.forename: Arash
authors.initials: A
authors.lastname: Salavitabar
authors.affiliation: Division of Pediatric Cardiology, Columbia University Medical Center, 3959 Broadway, CH 2N, New York, NY 10032, USA. Electronic address: bra2113@cumc.columbia.edu.
authors.forename: Brett R
authors.initials: BR
authors.lastname: Anderson
authors.affiliation: Division of Pediatric Surgery, Columbia University Medical Center, 3959 Broadway, CH 2N, New York, NY 10032, USA. Electronic address: ga2221@cumc.columbia.edu.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Aspelund
authors.affiliation: Division of Pediatric Cardiology, Columbia University Medical Center, 3959 Broadway, CH 2N, New York, NY 10032, USA. Electronic address: tjs1@cumc.columbia.edu.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Starc
authors.affiliation: Division of Pediatric Cardiology, Columbia University Medical Center, 3959 Broadway, CH 2N, New York, NY 10032, USA. Electronic address: wl2269@cumc.columbia.edu.
authors.forename: Wyman W
authors.initials: WW
authors.lastname: Lai
mesh_terms: D013505:Digestive System Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D059446:Heterotaxy Syndrome / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D045822:Intestinal Volvulus / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Heterotaxy syndrome; Intestinal malrotation; Intestinal rotational anomalies; Ladd procedure; Small bowel obstruction