Laparoscopic vs open Ladd's procedure for malrotation in neonates and infants: a propensity score matching analysis

Background: Laparoscopic Ladd's procedure for malrotation in children is still a controversial approach. Although some retrospective studies have compared the outcomes of the two types of procedure with inconsistency outcomes. Currently, there are few large-scale studies on laparoscopic treatment in malrotation with neonates and infants. We did a study based on propensity score matching to compare the effects of the two kinds of approach in neonates and infants. To investigate the therapeutic effect of laparoscopy and open Ladd's procedure by the propensity score-matching (PSM) to enhance the validity of the comparison.

Methods: A total series of 143 cases of intestinal malrotation without intestinal necrosis was included in the study during the 8 years from January 2012 to January 2020, including 68 cases of open Ladd's procedure and 75 cases of laparoscopic Ladd's procedure including five cases of transfer laparotomy. By a propensity score 1:1 matching, 62 patients were stratified for each group.

Results and conclusion: There was no significant difference in volvulus degree, weight and gender between the two groups (p > 0.05). Laparoscopic surgery took more time than open surgery (105.9 min vs 70.6 min, p < 0.05), but it had less hospital stay (12.4 days vs 14.6 days, p < 0.05) or less incision infection (0 vs 6, p < 0.05). There was no significant difference between the two groups at the time of first defecation, blood loss, time of full feeding and reoperation (p > 0.05). The cosmetic effect of laparoscopic surgery is better than that of open surgery. Laparoscopic Ladd's procedure is a safe approach. It can reduce the length of hospital stay and incision infection, but the operation time was extended, the other complications are similar compared with open procedure for intestinal malrotation in neonates and infants.