Laparoscopic strategy vs primary laparotomy for Ladd procedure in children with intestinal malrotation: A single-center retrospective intention-to-treat study

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BACKGROUNDIntestinal malrotation in children may cause bowel obstruction and midgut volvulus.The Ladd procedure remains the standard surgical correction, but the role of laparoscopy in neonates and small infants remains debated because of concerns about technical completeness, bowel viability assessment, and recurrence. AIMTo compare perioperative outcomes of laparoscopic strategy and primary laparotomy for Ladd procedure in children. METHODSThis retrospective single-center observational study included 37 children who underwent Ladd procedure for clinically significant intestinal malrotation between 2017 and 2021.Patients were compared according to the initially selected surgical strategy using the intention-to-treat principle: Primary open Ladd procedure (n = 15) vs laparoscopically initiated surgery (n = 22), including two conversions.Continuous variables were compared using the Mann-Whitney U test and categorical variables using Fisher's exact test. RESULTSOperative time did not differ significantly between groups: 62.5 (52.5-107.5)minutes vs 70.0 (55.0-105.0)minutes (P = 0.750).Two laparoscopically initiated procedures required conversion because of small-bowel perforation or subtotal small-bowel necrosis.No intraoperative complications occurred.Postoperative complications were recorded in 1/15 (7%) vs 3/22 (14%) patients (P = 0.633), mortality in 2/15 (13%) vs 2/22 (9%) (P = 1.000), and reoperation for bowel obstruction in 1/13 (8%) vs 4/19 (21%) patients with available follow-up (P = 0.625).Feeding restart, intensive care unit stay, and postoperative hospitalization also did not differ significantly. CONCLUSIONLaparoscopic Ladd procedure was feasible in selected children, provided that conversion was used when safe assessment or complete revision was uncertain.