title: Intestinal Malrotation and Volvulus in Neonates: Laparoscopy Versus Open Laparotomy.
abstract: BACKGROUND
  Intestinal malrotations with midgut volvulus are surgical emergencies that can lead to life-threatening intestinal necrosis. This study evaluates the feasibility and the outcomes of laparoscopic treatment of midgut volvulus compared with classic open Ladd's procedure in neonates.
  
  
  METHODS
  The medical records of all neonates with diagnosis of malrotation and volvulus, who underwent surgery between January 1993 and January 2014, were reviewed. We considered the group of neonates laparoscopically treated (Group A, n = 20) and we compared it with an equal number of neonates treated with the classical open Ladd's procedure (Group B, n = 20).
  
  
  RESULTS
  The median age at surgery was 8.4 days and the mean weight was 3.340 kg. The suspicion of volvulus was documented by plain abdominal radiograph, upper gastrointestinal contrast study, and/or ultrasound scanning of the mesenteric vessels. All the patients were treated according to the Ladd's procedure. Conversion to an open procedure was necessary in 25% of the patients. The mean operative time was 80 minutes (28-190 minutes) in Group A and 61 minutes (40-130 minutes) in Group B (P = .04). The median time to full diet (P = .02) and hospital stay (P = .04) was better in Group A. Rehospitalization because of recurrence of occlusive symptoms occurred in 30% of patients in Group A (n = 6) and in 40% of patients in Group B (n = 8). Among these, all the 6 patients of Group A underwent redo surgery for additional division of Ladd's bands or debridement; instead in Group B, 4 of 8 patients underwent open redo surgery.
  
  
  CONCLUSIONS
  Laparoscopic exploration is the procedure of choice in case of suspicion of intestinal malrotation and volvulus. Laparoscopic treatment is feasible and safe even in neonatal age without additional risks compared with classical open Ladd's procedure.
authors.affiliation: 1 Department of Pediatric Surgery, University Hospitals , Strasbourg, France .
authors.forename: Luisa
authors.initials: L
authors.lastname: Ferrero
authors.affiliation: 2 Department of Pediatric Surgery, Lapeyronie University Hospital , Montpellier, France .
authors.forename: Yosra Ben
authors.initials: YB
authors.lastname: Ahmed
authors.affiliation: 3 Department of Pediatric Surgery, University Hospital , Luxembourg, Luxembourg .
authors.forename: Paul
authors.initials: P
authors.lastname: Philippe
authors.affiliation: 4 Department of Pediatric Surgery, University Hospital , Lausanne, Switzerland .
authors.forename: Olivier
authors.initials: O
authors.lastname: Reinberg
authors.affiliation: 1 Department of Pediatric Surgery, University Hospitals , Strasbourg, France .
authors.forename: Isabelle
authors.initials: I
authors.lastname: Lacreuse
authors.affiliation: 1 Department of Pediatric Surgery, University Hospitals , Strasbourg, France .
authors.forename: Anne
authors.initials: A
authors.lastname: Schneider
authors.affiliation: 1 Department of Pediatric Surgery, University Hospitals , Strasbourg, France .
authors.forename: Raphael
authors.initials: R
authors.lastname: Moog
authors.affiliation: 3 Department of Pediatric Surgery, University Hospital , Luxembourg, Luxembourg .
authors.forename: Cindy
authors.initials: C
authors.lastname: Gomes-Ferreira
authors.affiliation: 1 Department of Pediatric Surgery, University Hospitals , Strasbourg, France .
authors.forename: François
authors.initials: F
authors.lastname: Becmeur
mesh_terms: D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D004065:Digestive System Abnormalities / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D045822:Intestinal Volvulus / Q000601:surgery*; D010535:Laparoscopy; D007813:Laparotomy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D061646:Operative Time; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Ladd's procedure; intestinal malrotation; laparoscopy; neonates; volvulus