Jason A Fawley1, Abdelhafeez H Abdelhafeez2, Jessica A Schultz1, Allison Ertl3, Laura D Cassidy1, Shawn St Peter4, Amy J Wagner5. 1. Medical College of Wisconsin, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI. 2. The Children's University Hospital, Dublin, Ireland. 3. Medical College of Wisconsin, Milwaukee, WI. 4. Children's Mercy Hospital, Kansas City, MO. 5. Medical College of Wisconsin, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI. Electronic address: AWagner@chw.org.
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. LEVEL OF EVIDENCE: III; retrospective comparative study.
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. LEVEL OF EVIDENCE: III; retrospective comparative study.
Authors: Kareem Abu-Elmagd; George Mazariegos; Sherif Armanyous; Neha Parekh; Ayat ElSherif; Ajai Khanna; Beverly Kosmach-Park; Giuseppe D'Amico; Masato Fujiki; Mohammed Osman; Marissa Scalish; Amanda Pruchnicki; Elizabeth Newhouse; Ahmed A Abdelshafy; Erick Remer; Guilherme Costa; R Matthew Walsh Journal: Ann Surg Date: 2021-10-01 Impact factor: 12.969