title: The risk of midgut volvulus in patients with abdominal wall defects: A multi-institutional study.
abstract: BACKGROUND
  The management of malrotation in patients with congenital abdominal wall defects has varied among surgeons. We were interested in investigating the risk of midgut volvulus in patients with gastroschisis and omphalocele to help determine if these patients may benefit from undergoing a Ladd procedure.
  
  
  METHODS
  A retrospective chart review was performed for all patients managed at three institutions born between 1/1/2000 and 12/31/2008 with a diagnosis of gastroschisis or omphalocele. Patient charts were reviewed through 12/31/2012 for occurrence of midgut volvulus or need for second laparotomy.
  
  
  RESULTS
  Of the 414 patients identified with abdominal wall defects, 299 patients (72%) had gastroschisis, and 115 patients (28%) had omphalocele. The mean gestational age at birth was 36.1±2.3weeks, and the mean birth weight was 2.57±0.7kg. There were a total of 8 (1.9%) cases of midgut volvulus: 3 (1.0%) patients with gastroschisis compared to 5 patients (4.4%) with omphalocele (p=0.04).
  
  
  CONCLUSIONS
  Patients with omphalocele have a greater risk of developing midgut volvulus, and a Ladd procedure should be considered during definitive repair to mitigate these risks.
  
  
  METHODS
  III; retrospective comparative study.
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Fawley
authors.affiliation: The Children's University Hospital, Dublin, Ireland.
authors.forename: Abdelhafeez H
authors.initials: AH
authors.lastname: Abdelhafeez
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Schultz
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Allison
authors.initials: A
authors.lastname: Ertl
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Cassidy
authors.affiliation: Children's Mercy Hospital, Kansas City, MO.
authors.forename: Shawn St
authors.initials: SS
authors.lastname: Peter
authors.affiliation: Medical College of Wisconsin, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI. Electronic address: AWagner@chw.org.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Wagner
mesh_terms: D001724:Birth Weight; D004065:Digestive System Abnormalities / Q000209:etiology*; D005260:Female; D020139:Gastroschisis / Q000150:complications* / Q000601:surgery*; D005865:Gestational Age; D006554:Hernia, Umbilical / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D045822:Intestinal Volvulus / Q000209:etiology*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Gastroschisis; Ladd procedure; Midgut volvulus; Omphalocele