Comparing laparoscopic versus open Ladd's procedure in pediatric patients

Justin T. Huntington, Joseph J. Lopez, Justin B. Mahida, Erica J. Ambeba, Lindsey Asti, Katherine J. Deans, Peter C. Minneci

Research output: Contribution to journalArticlepeer-review

Abstract

Background/purpose: The objective of this study was to perform a comparative analysis of laparoscopic versus open Ladd's procedure on 30-day postoperative outcomes. Methods: All elective Ladd's procedures performed on patients with intestinal malrotation in the 2013-2014 National Surgical Quality Improvement Program Pediatric were identified. A propensity score-matched analysis was used to account for baseline differences between groups, and generalized estimating equations (GEEs) were used to compare 30-day outcomes between open versus laparoscopic groups. Results: Fifty-eight (18.6%) patients underwent laparoscopic Ladd's while 253 (81.4%) underwent an open technique. After propensity score matching, 53 laparoscopic cases (38.1%) and 86 open cases (61.9%) were identified and compared for outcomes. Total length of stay was shorter for the laparoscopic group compared to the open group (6 vs. 4. days,. p < 0.001). Postoperative length of stay was shorter for the laparoscopic group as well (5 vs. 4. days,. p < 0.001). Postoperative complications occurred in 5 laparoscopic cases (9.4%) and in 18 open cases (20.9%), but did not meet statistical significance (p = 0.08). One laparoscopic patient (1.9%) and 8 open patients (9.3%) required hospitalization beyond 30. days, but this also did not meet significance (p = 0.08). Conclusions: In a matched analysis, laparoscopic Ladd's led to shorter hospital stays than open Ladd's in the initial 30-day postoperative period. Short-term benefits of laparoscopic Ladd's lend support for using additional resources to perform multi-institutional studies to compare differences in long-term outcomes between laparoscopic and open Ladd's. Type of study: Therapeutic + Level of evidence: III +

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StateAccepted/In press - Jul 18 2016
Externally publishedYes

Keywords

  • Ladd's
  • Laparoscopic
  • Laparoscopy
  • Malrotation
  • Volvulus

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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