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Observation versus prophylactic Ladd procedure for asymptomatic intestinal rotational abnormalities in heterotaxy syndrome: A systematic review
- Source :
- Journal of pediatric surgery. 50(11)
- Publication Year :
- 2015
-
Abstract
- Background The management of intestinal rotational abnormalities (IRA) in heterotaxy syndrome (HS) remains inconsistent. Because of the high incidence of malrotation in HS, screening of asymptomatic patients is standard of care in some institutions. The Ladd procedure is the treatment for malrotation, and has been reported to have high complication rates in HS patients. Methods We performed a systematic review of publications describing IRA in pediatric HS patients from January 1993 to present. The incidence of volvulus on surgical exploration was determined. Perioperative and long-term outcomes were analyzed to determine complication and mortality rates. Results Eleven retrospective studies describing 649 HS patients were identified. Of all patients with HS, 27% (176/649) underwent Ladd procedure. Only 1.2% (8/649) of HS patients included had volvulus. Postoperative complications occurred in 25 patients (14%), including a 10% incidence of small bowel obstruction. Perioperative and overall mortality rates after Ladd procedure were 3% and 21%, respectively. Six studies described mesenteric width, reporting 43% to have narrow mesentery. Conclusion The Ladd procedure is not without significant morbidity and mortality in heterotaxy patients. Further prospective studies should investigate predictors of mesenteric width to spare the unnecessary morbidity of surgery in patients who are at low risk for volvulus.
- Subjects :
- Male
medicine.medical_specialty
Adolescent
Heterotaxy Syndrome
Asymptomatic
Postoperative Complications
Medicine
Humans
Mesentery
Child
Watchful Waiting
Digestive System Surgical Procedures
Retrospective Studies
business.industry
Mortality rate
Incidence
Infant
Retrospective cohort study
General Medicine
Perioperative
medicine.disease
Volvulus
Surgery
Bowel obstruction
Intestines
Child, Preschool
Pediatrics, Perinatology and Child Health
Asymptomatic Diseases
Female
medicine.symptom
business
Complication
Heterotaxy
Intestinal Obstruction
Intestinal Volvulus
Subjects
Details
- ISSN :
- 15315037
- Volume :
- 50
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- Journal of pediatric surgery
- Accession number :
- edsair.doi.dedup.....06fd70aa051d134d462e77f80c01f9cf