Zou Chanjuan,Li Bo,Dong Jie,et al.Laparoscopic “spindle” repositioning approach for neonatal congenital intestinal malrotation[J].Journal of Clinical Pediatric Surgery,,22():944-947.[doi:10.3760/cma.j.cn101785-202306041-008]
Laparoscopic “spindle” repositioning approach for neonatal congenital intestinal malrotation
- Keywords:
- Congenital Intestinal Malrotation; Surgical Procedures; Operative; Laparoscopy; Infant; Neonates
- Abstract:
- Objective To introduce a new laparoscopic "spindle" repositioning approach for managing neonatal congenital intestinal malrotation (CIM) and analyze its efficacy and feasibility.Methods From January 2015 to June 2021,228 CIM children were collected.There were 96 boys and 132 girls with an age range of 8(3-28) days and a weight range of 3.5(2.0-4.3) Kg.Perioperative data and follow-up outcomes were recorded.Measurements with a normal distribution were described by mean and standard deviation while measurements with an abnormal distribution by median and interquartile range.The categorical variables are statistically described in terms of frequency and percentage.Results Among them,174(77.6%) were initially diagnosed with vomiting.And 48 cases (21.4%) had a clinical presentation of bloody stool.And 6 cases (2.6%) were detected incidentally during abdominal ultrasonography for other reasons.A definite diagnosis of CIM was confirmed after contrast study.Average duration of procedure was (58±15) min,postoperative milk resumption time 2.5(1-4) days and hospitalization stay 11.0(9-18) days.Forty-four patients underwent open surgery.The main reasons for converting into open surgery included pneumatization of dilated bowel (n=25,56.8%),concurrent Michael’s diverticulum (n=14,31.8%) and lumpectomic difficulty in achieving hemostasis during laparoscopy (n=4,9.0%).During follow-ups,9 cases of recurrent CIM occurred at Day 10 to Month 30.After re-operation,all of them were discharged and recovered well at the final follow-up.Four children had vomiting during feeding post-discharge and improved after conservative measures.Conclusion Laparoscopic "spindle" repositioning approach for CIM is simple,convenient and easy-to-master in neonates.Wider popularization is worthwhile.
References:
[1] Graziano K,Islam S,Dasgupta R,et al.Asymptomatic malrotation:diagnosis and surgical management:an American Pediatric Surgical Association outcomes and evidence based practice committee systematic review[J].J Pediatr Surg,2015,50(10):1783-1790.DOI:10.1016/j.jpedsurg.2015.06.019.
[2] Ladd WE.Surgical diseases of the alimentary tract in infants[J].N Engl J Med,1936,215:705-708.DOI:10.1056/NEJM193610152151604.
[3] van der Zee DC,Bax NM.Laparoscopic repair of acute volvulus in a neonate with malrotation[J].Surg Endosc,1995,9(10):1123-1124.DOI:10.1007/BF00189001.
[4] Catania VD,Lauriti G,Pierro A,et al.Open versus laparoscopic approach for intestinal malrotation in infants and children:a systematic review and meta-analysis[J].Pediatr Surg Int,2016,32(12):1157-1164.DOI:10.1007/s00383-016-3974-2.
[5] Arnaud AP,Suply E,Eaton S,et al.Laparoscopic Ladd’s procedure for malrotation in infants and children is still a controversial approach[J].J Pediatr Surg,2019,54(9):1843-1847.DOI:10.1016/j.jpedsurg.2018.09.023.
[6] Miyano G,Fukuzawa H,Morita K,et al.Laparoscopic repair of malrotation:what are the indications in neonates and children?[J].J Laparoendosc Adv Surg Tech A,2015,25(2):155-158.DOI:10.1089/lap.2014.0236.
[7] Scalabre A,Duquesne I,Deheppe J,et al.Outcomes of laparoscopic and open surgical treatment of intestinal malrotation in children[J].J Pediatr Surg,2020,55(12):2777-2782.DOI:10.1016/j.jpedsurg.2020.08.014.
[8] Palanivelu C,Rangarajan M,Shetty AR,et al.Intestinal malrotation with midgut volvulus presenting as acute abdomen in children:value of diagnostic and therapeutic laparoscopy[J].J Laparoendosc Adv Surg Tech A,2007,17(4):490-492.DOI:10.1089/lap.2006.0103.
[9] Kisku S.Orbit technique in malrotation with non-obstructive volvulus:a novel technique of devolvulation[J].Asian J Endosc Surg,2017,10(2):213-215.DOI:10.1111/ases.12344.
[10] Pham HD,Okata Y,Vu HM,et al.Laparoscopic Ladd’s procedure in neonates:a simple landmark detorsion technique[J].Pediatr Int,2020,62(7):828-833.DOI:10.1111/ped.14194.
[11] Agrawal V,Tiwari A,Acharya H,et al.Laparoscopic ’steering wheel’ derotation technique for midgut volvulus in children with intestinal malrotation[J].J Minim Access Surg,2019,15(3):219-223.DOI:10.4103/jmas.JMAS_24_18.
[12] Ooms N,Matthyssens LEM,Draaisma JM,et al.Laparoscopic treatment of intestinal malrotation in children[J].Eur J Pediatr Surg,2016,26(4):376-381.DOI:10.1055/s-0035-1554914.
[13] Stanfill AB,Pearl RH,Kalvakuri K,et al.Laparoscopic Ladd’s procedure:treatment of choice for midgut malrotation in infants and children[J].J Laparoendosc Adv Surg Tech A,2010,20(4):369-372.DOI:10.1089/lap.2009.0118.
[14] Zhu HT,Zheng S,Alganabi M,et al.Reoperation after Ladd’s procedure in the neonatal period[J].Pediatr Surg Int,2019,35(1):117-120.DOI:10.1007/s00383-018-4382-6.
Memo
收稿日期:2023-6-26。
基金项目:湖南省出生缺陷协同防治科技重大专项(2019SK1015)
通讯作者:周崇高,Email:zhoucg_hnch@163.com