Aurélien Scalabre1, Igor Duquesne2, Jérome Deheppe3, Guillaume Rossignol4, Sabine Irtan2, Alexis Arnaud5, Quentin Ballouhey6, Olivier Abbo7, Pierre-Yves Rabattu8, Aurélien Binet9, François Varlet3. 1. Department of Pediatric Surgery, CHU de Saint-Etienne, Saint-Etienne, France. Electronic address: aurelien.scalabre@chu-st-etienne.fr. 2. Department of Pediatric Surgery, Trousseau Hospital - Assistance Publique des Hôpitaux de Paris, Paris, France. 3. Department of Pediatric Surgery, CHU de Saint-Etienne, Saint-Etienne, France. 4. Department of Pediatric Surgery, Hospices Civils de Lyon, France. 5. Department of Pediatric Surgery, CHU de Rennes, Rennes, France. 6. Department of Pediatric Surgery, CHU de Limoges, Limoges, France. 7. Department of Pediatric Surgery, CHU de Toulouse, Toulouse, France. 8. Department of Pediatric Surgery, CHU de Grenoble, Grenoble, France. 9. Department of Pediatric Surgery, CHU de Tours, Tours, France.
Abstract
BACKGROUND: The safety of the laparoscopic treatment of intestinal malrotation remains controversial. This study compared the outcomes of laparoscopic and open surgical treatment of intestinal malrotation. METHODS: A multicentric retrospective study included pediatric cases of intestinal malrotation operated on between 2005 and 2016. RESULTS: This study included 227 children with a median age of 17 days (0-17.2 years), including 161 with a midgut volvulus. Forty-six(20.3%) procedures were started by laparoscopy and 181(79.7%) by laparotomy. Laparoscopy was more frequent for elective surgery (45.9%) than for emergency procedures (10.8%, p < 0.001). Conversions were significantly more frequent during emergency procedures (66.7% vs 17.9%)(p = 0.001). Considering only 61 elective surgeries, the mean hospital stay was significantly shorter after laparoscopy (5.3 days +/-5.2 vs 10.1 days +/-13, p = 0.01), the overall complication rate was comparable (15.8% vs 21.7%, p = 0.7) but post-operative volvulus was significantly more frequent after laparoscopy (13% vs 0%, p = 0.04). Outcomes of the two approaches were not significantly different after 166 emergency procedures. CONCLUSION: Laparoscopy can be performed by experienced team for the treatment of selected cases of intestinal malrotation. Conversion to open surgery should be done with a low threshold, as the rate of volvulus recurrence is concerning. LEVEL OF EVIDENCE: Level III.
BACKGROUND: The safety of the laparoscopic treatment of intestinal malrotation remains controversial. This study compared the outcomes of laparoscopic and open surgical treatment of intestinal malrotation. METHODS: A multicentric retrospective study included pediatric cases of intestinal malrotation operated on between 2005 and 2016. RESULTS: This study included 227 children with a median age of 17 days (0-17.2 years), including 161 with a midgut volvulus. Forty-six(20.3%) procedures were started by laparoscopy and 181(79.7%) by laparotomy. Laparoscopy was more frequent for elective surgery (45.9%) than for emergency procedures (10.8%, p < 0.001). Conversions were significantly more frequent during emergency procedures (66.7% vs 17.9%)(p = 0.001). Considering only 61 elective surgeries, the mean hospital stay was significantly shorter after laparoscopy (5.3 days +/-5.2 vs 10.1 days +/-13, p = 0.01), the overall complication rate was comparable (15.8% vs 21.7%, p = 0.7) but post-operative volvulus was significantly more frequent after laparoscopy (13% vs 0%, p = 0.04). Outcomes of the two approaches were not significantly different after 166 emergency procedures. CONCLUSION: Laparoscopy can be performed by experienced team for the treatment of selected cases of intestinal malrotation. Conversion to open surgery should be done with a low threshold, as the rate of volvulus recurrence is concerning. LEVEL OF EVIDENCE: Level III.