title: Comparing laparoscopic versus open Ladd's procedure in pediatric patients.
abstract: OBJECTIVE
  The objective of this study was to perform a comparative analysis of laparoscopic versus open Ladd's procedure on 30-day postoperative outcomes.
  
  
  METHODS
  All elective Ladd's procedures performed on patients with intestinal malrotation in the 2013-2014 National Surgical Quality Improvement Program Pediatric were identified. A propensity score-matched analysis was used to account for baseline differences between groups, and generalized estimating equations (GEEs) were used to compare 30-day outcomes between open versus laparoscopic groups.
  
  
  RESULTS
  Fifty-eight (18.6%) patients underwent laparoscopic Ladd's while 253 (81.4%) underwent an open technique. After propensity score matching, 53 laparoscopic cases (38.1%) and 86 open cases (61.9%) were identified and compared for outcomes. Total length of stay was shorter for the laparoscopic group compared to the open group (6 vs. 4days, p<0.001). Postoperative length of stay was shorter for the laparoscopic group as well (5 vs. 4days, p<0.001). Postoperative complications occurred in 5 laparoscopic cases (9.4%) and in 18 open cases (20.9%), but did not meet statistical significance (p=0.08). One laparoscopic patient (1.9%) and 8 open patients (9.3%) required hospitalization beyond 30days, but this also did not meet significance (p=0.08).
  
  
  CONCLUSIONS
  In a matched analysis, laparoscopic Ladd's led to shorter hospital stays than open Ladd's in the initial 30-day postoperative period. Short-term benefits of laparoscopic Ladd's lend support for using additional resources to perform multi-institutional studies to compare differences in long-term outcomes between laparoscopic and open Ladd's.
  
  
  METHODS
  Therapeutic LEVEL OF EVIDENCE: III.
authors.affiliation: Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
authors.forename: Justin T
authors.initials: JT
authors.lastname: Huntington
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Lopez
authors.affiliation: Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Mahida
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors.forename: Erica J
authors.initials: EJ
authors.lastname: Ambeba
authors.affiliation: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Asti
authors.affiliation: Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Deans
authors.affiliation: Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH; Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH. Electronic address: Peter.Minneci@nationwidechildrens.org.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D045822:Intestinal Volvulus / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D057216:Propensity Score; D016896:Treatment Outcome
keywords: Ladd's; Laparoscopic; Laparoscopy; Malrotation; Volvulus