title: Current surgical management of intestinal rotational abnormalities.
abstract: OBJECTIVE
  At present, there is a debate as to the management of malrotation in pediatric patients. This review highlights recent literature including the role of laparoscopy, and the management of asymptomatic patients with and without congenital cardiac disease.
  
  
  RESULTS
  Symptomatic patients are still recommended to undergo open Ladd's procedure. Laparoscopic Ladd's procedure in asymptomatic patients confers a shorter time to tolerating feeds, shorter length of stay, and a decreased rate of bowel obstruction and other complications. It may, however, carry a higher risk of postoperative volvulus. Diagnostic laparoscopy is recommended in asymptomatic patients in whom the diagnosis is uncertain on upper gastrointestinal imaging. Asymptomatic patients with congenital heart disease may be managed with initial observation or operation, based upon individualized risk benefit assessment. If an elective Ladd's procedure is performed, it should take place after palliative cardiac operations have resulted in stable cardiac function. Screening upper gastrointestinal studies in heterotaxy patients may be unnecessary as the reported rates of volvulus in recent studies are low.
  
  
  CONCLUSIONS
  Laparoscopic Ladd's procedure may be an acceptable alternative to an open procedure for asymptomatic patients. Observation of asymptomatic patients with congenital cardiac disease is a reasonable alternative in selected patients.
authors.affiliation: Center for Surgical Outcomes Research, Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, and Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Lodwick
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Deans
mesh_terms: D002648:Child; D004065:Digestive System Abnormalities / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000453:epidemiology*; D006801:Humans; D045822:Intestinal Volvulus / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation; D018570:Risk Assessment; D016896:Treatment Outcome