Effect of Adhesion Barrier Use During Ladd Procedure for Intestinal Malrotation on Postoperative Midgut Volvulus and Postoperative Small Bowel Obstruction: A Retrospective Cohort Study Using a National Inpatient Database

Background: Postoperative midgut volvulus is a life-threatening complication following Ladd procedure. Adhesion barrier to prevent postoperative small bowel obstruction could increase postoperative midgut volvulus incidence due to reduced adhesions. We aimed to examine effect of adhesion barrier use during Ladd procedures on postoperative midgut volvulus and postoperative small bowel obstruction. Study Design: We retrospectively identified patients aged<18 years who underwent Ladd procedure between April 2016 and March 2021, using a Japanese nationwide inpatient database. We employed propensity-score overlap-weighting analyses to compare reoperation for midgut volvulus, rehospitalization and operation for small bowel obstruction, mortality, total rehospitalization length, and total rehospitalization cost within 1 year after the Ladd procedure between patients in whom adhesion barrier was used (barrier group) and patients in whom it was not used (non-barrier group). Results: Of the 1,159 eligible patients, adhesion barrier was used in 314 and not used in 845 patients. The proportion of reoperation for midgut volvulus did not differ between the barrier and non-barrier groups (3.5% vs. 2.7%; risk difference, 0.8%; 95% confidence interval, -1.9 to 3.5). The proportion of rehospitalization due to small bowel obstruction was lower in the barrier group than in the non-barrier group (2.6% vs. 6.3%; risk difference, -3.6%; 95% confidence interval, -6.6 to -0.8). No significant differences were observed in operation for small bowel obstruction, mortality, and total length and cost of rehospitalization. Conclusion: Use of adhesion barrier during Ladd procedure can prevent rehospitalization due to postoperative small bowel obstruction without increasing the incidence of postoperative midgut volvulus.