Laparoscopic Versus Open Surgery for Malrotation without Volvulus

Purpose: We wished to determine the risks and benefits of laparoscopic surgery when compared to the standard open approach in the management of children with malrotation without volvulus. Patients and Methods: Eighteen children undergoing laparoscopic surgery were compared to 20 similar children having open surgery during the same time period (1994-1999). Results: Three laparoscopic cases were converted. Six (33%) laparoscopic patients were found to have a broad-based mesentery at laparoscopy, and underwent appendectomy alone. The rest went on to a Ladd procedure. Eight (40%) open patients were found intraoperatively to have a broad-based mesentery. The laparoscopic group required less narcotic, was faster to full feeds, and had a shorter mean postoperative stay. On followup, there were no late complications in the laparoscopic group, but 2 (10%) open surgery patients developed adhesive small bowel obstruction. There were no cases of late volvulus following either laparoscopic or open surgery. Conclusion: Laparoscopy permits direct evaluation of the mesenteric base, with the option of a laparoscopic Ladd procedure if indicated. It results in less postoperative pain, decreased ileus, and a shorter hospitalization. The laparoscopic approach is safe and effective, and does not appear to be associated with an increased risk of late volvulus.