Background

Laparoscopic Ladd's procedure has been proven safe and effective for the treatment of malrotation. However, the nationwide utilization and outcomes of elective Ladd's procedure are largely unknown.

Methods

The Nationwide Readmissions Database from 2010 to 2014 was used to identify patients 0–18 years (excluding newborns) with malrotation who underwent elective Ladd's procedure. Demographics, hospital factors, and outcomes were compared by approach (laparoscopic vs. open) using standard statistical tests and propensity score (PS) matched analysis. Results were weighted for national estimates.

Results

1343 patients (44% male) underwent elective Ladd's procedure via laparoscopic (22%) or open (78%) approach. Laparoscopic approach was more common in large hospitals (26% vs. 16%), patients >13 years (30% vs. 20%), and those with higher income (29% vs. 16%), all p < 0.001. Following PS matching, compared to the laparoscopic approach, open Ladd's was associated with index hospital length of stay > 7 days (20% vs. 8%), more post-operative gastrointestinal dysfunction (12% vs. < 1%), and more nausea, vomiting, and/or diarrhea (16% vs. 6%), all p < 0.001. The overall readmission rates within 30 days and the year of index operation were 8% and 15%, respectively. In the matched cohort, those undergoing laparoscopic Ladd's were less likely to be readmitted than those with the open approach (7% vs. 16%, p < 0.001) and experienced less gastrointestinal issues on readmission (5% vs. 15%, p = 0.002). There were similar rates of post-operative small bowel obstruction (< 3% vs. < 3%, p = 0.840) and volvulus (0% vs. < 1%, p = 0.136). Redo Ladd's procedure was performed in less than 4% of readmissions and all occurred within 5 days of initial hospital discharge.

Conclusion

The majority of Ladd's procedures in the U.S. are being performed open, despite comparable outcomes following a laparoscopic approach. Readmission rates are similar with either approach, and the rate of redo Ladd's procedure is lower than previously reported.

Level of evidence

Level III.

中文翻译：

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Ladd 程序的结果：方法重要吗？

背景

腹腔镜 Ladd 手术已被证明可安全有效地治疗旋转不良。然而，选择性 Ladd 程序在全国范围内的使用和结果在很大程度上是未知的。

方法

2010 年至 2014 年的全国再入院数据库用于识别 0-18 岁（不包括新生儿）接受择期 Ladd 手术的旋转不良患者。使用标准统计测试和倾向评分 (PS) 匹配分析，通过方法（腹腔镜与开放）比较人口统计学、医院因素和结果。结果根据国家估计值进行加权。

结果

1343 名患者（44% 男性）通过腹腔镜（22%）或开放（78%）方法接受了选择性 Ladd 手术。腹腔镜方法在大型医院（26% 对 16%）、>13 岁的患者（30% 对 20%）和收入较高的患者（29% 对 16%）中更为常见，所有p  < 0.001。在 PS 匹配后，与腹腔镜方法相比，开放式 Ladd 与指数住院时间 > 7 天（20% 对 8%）、更多的术后胃肠功能障碍（12% 对 <1%）等相关恶心、呕吐和/或腹泻（16% 对 6%），所有p < 0.001。30 天内的总体再入院率和指数手术年份分别为 8% 和 15%。在匹配队列中，接受腹腔镜 Ladd 手术的患者再入院的可能性低于采用开放式手术的患者（7% 对 16%，p  < 0.001），并且在再入院时出现的胃肠道问题更少（5% 对 15%，p  = 0.002)。术后小肠梗阻（< 3% vs. < 3%，p  = 0.840）和肠扭转（0% vs. < 1%，p  = 0.136）的发生率相似。Redo Ladd 手术在不到 4% 的再入院中进行，并且全部发生在初次出院后 5 天内。

结论

尽管腹腔镜手术后的结果相当，但在美国，Ladd 的大部分手术都是在开放式进行的。两种方法的再入院率相似，重做 Ladd 程序的比率低于先前报道的。

证据级别

三级。