Детская хирургия. Журнал им. Ю.Ф. Исакова. 2023; 27: 168-175
Сравнительные результаты лечения мальротации кишечника у новорождённых способами лапароскопии и лапаротомии
https://doi.org/10.55308/1560-9510-2023-27-3-168-175Аннотация
Введение. Открытая операция Ледда является стандартным методом лечения мальротации кишечника. С внедрением в практику хирургических вмешательств лапароскопии количество сообщений об успешном лечении данного порока с помощью миниинвазивных методик растёт. Но мало сообщений посвящено коррекции данного порока у новорождённых.
Цель исследования – улучшение лечения новорождённых с мальротацией кишечника.
Материал и методы. Проведён ретроспективный и проспективный анализ 77 новорождённых с диагнозом мальротация кишечника с 2002 по 2020 гг. Исследуемую (1-ю) группу составили 35 новорождённых, которым проведена операция лапароскопическим способом, контрольную (2-ю) – 42 пациента, которым проведена открытая операция (лапаротомия). Для статистической обработки данных использовали программу StatTech (разработчик ООО «Статтех», Россия).
Результаты. Группы были сопоставимы по антропометрическим показателям, гендерному составу, гестационному сроку. При исследовании были получены следующие различия: при лапароскопии операция длится дольше, чем при открытой операции. В 1-й группе пациентов реанимационный период протекал гладко, пассаж по кишечнику восстанавливался быстрее, энтеральное кормление начиналось быстрее. Количество койко-дней при применении малоинвазивных методик сокращается, в сравнении с открытой операцией, после которой дети чаще требуют проведения стимуляции кишечника с целью восстановления пассажа по желудочно-кишечному тракту. Развитие осложнений не зависит от способа выполнения операции. Развитие рецидива в обеих группах сопоставимо, нарушение техники оперативного вмешательства является ведущим фактором развития рецидива вне зависимости от способа операции.
Заключение. Лапароскопическая коррекция мальротации показывает хорощие послеоперационные результаты. Данный доступ может быть применён в крупных центрах, имеющих необходимое оборудование и большой опыт выполнения лапароскопических операций.
Список литературы
1. Stanfill A.B., Pearl R.H., Kalvakuri K., et al. Laparoscopic Ladd’s procedure: treatment of choice for midgut malrotation in infants and children.. J Laparoendosc Adv Surg Tech. 2010; 20(4): 369–72. https://doi.org/10.1089/lap.2009.01182
2. Miyano G., Fukuzawa H., Morita K., Kaneshiro M., Miyake H., Nouso H., Yamoto M., Fukumoto K., Urushihara N. Laparoscopic repair of malrotation: what are the indications in neonates and children? J Laparoendosc Adv Surg Tech A. 2015; 25(2): 155–8. https://doi.org/10.1089/lap.2014.0236
3. Zani A., Pierro A. Intestinal malrotation. In: Puri P. (ed). Newborn surgery, 4th ed. CRC Press, Boca Raton, FL (in press); 2017.
4. Lin J.N., Lou C.C., Wang K.L. Intestinal malrotation and midgut volvulus: a 15-year review. J Formos Med Assoc Taiwan yizhi. 1995; 94(4): 178–81.
5. Lampl B., Levin T.L., Berdon W.E., et al. Malrotation and midgut volvulus: a historical review and current controversies in diagnosis and management. Pediatr Radiol. 2009; 39(4): 359–66.
6. Ford E.G., Senac M.O. Jr, Srikanth M.S., Weitzman J.J. Malrotation of the intestine in children. Ann Surg. 1992; 215(2): 172–8. https://doi.org/10.1097/00000658-199202000-00013
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10. Miyano G., Fukuzawa H., Morita K., et al. Laparoscopic repair of malrotation: What are the indications in neonates and children? J Laparoendosc Adv Surg Tech. 2015; 25(2): 155–8. https://doi.org/10.1089/lap.2014.0236
11. Pham H.D., Okata Y., Vu H.M., et al. Laparoscopic Ladd’s procedure in neonates: A simple landmark detorsion technique. Pediatr Int. 2020; 62(7): 828–33. https://doi.org/10.1111/ped.14194
12. Svetanoff W.J., Sobrino J.A., Sujka J.A., St. Peter S.D., Fraser J.D. Laparoscopic Ladd procedure for the management of malrotation and volvulus. J Laparoendosc Adv Surg Tech. 2020; 30(2): 210–5. https://www.liebertpub.com/doi/10.1089/lap.2019.0602
13. Anand U., Kumar R., Priyadarshi R.N., Kumar B., Kumar S., Singh V.P. Comparative study of intestinal malrotation in infant, children, and adult in a tertiary care center in India. Indian J Gastroenterol. 2018; 37(6): 545–9. https://link.springer.com/10.1007/s12664-018-0914-1
14. Arnaud A.P., Suply E., Eaton S., Blackburn S.C., Giuliani S., Curry J.I., et al. Laparoscopic Ladd’s procedure for malrotation in infants and children is still a controversial approach. J Pediatr Surg. 2019; 54(9): 1843–7. https://doi.org/10.1016/j.jpedsurg.2018.09.023
15. Catania V.D., Lauriti G., Pierro A., Zani A. Open versus laparoscopic approach for intestinal malrotation in infants and children: a systematic review and meta-analysis. Pediatr Surg Int. 2016; 32(12): 1157–64.
16. Chacon C.S., Saxena A.K. Approach to intestinal malrotation in children in the laparoscopic era. J Pediatr Endosc Surg. 2019; (1): 137–42. https://doi.org/10.1007/s42804-019-00036-7
17. Da Costa K.M., Saxena A.K. Laparoscopic Ladd procedure for malrotation in newborns and infants. Am Surg. 2021; 87(2): 253–8.
18. Hagendoorn J., Vieira-Travassos D., Van Der Zee D. Laparoscopic treatment of intestinal malrotation in neonates and infants: Retrospective study. Surg Endosc. 2011; 25(1): 217–20.
19. Huntington J.T., Lopez J.J., Mahida J.B., Ambeba E.J., Asti L., Deans K.J., et al. Comparing laparoscopic versus open Ladd’s procedure in pediatric patients. J Pediatr Surg. 2017; 52(7): 1128–31. https://doi.org/10.1016/j.jpedsurg.2016.10.046
20. Isani M.A., Schlieve C., Jackson J., Elizee M., Asuelime G., Rosenberg D, et al. Is less more? Laparoscopic versus open Ladd’s procedure in children with malrotation. J Surg Res. 2018; 229: 351–6. https://doi.org/10.1016/j.jss.2018.04.016
21. Nasir A., Abdur-Rahman L., Adeniran J. Outcomes of surgical treatment of malrotation in children. African J Paediatr Surg. 2011; 8(1): 8. https://www.afrjpaedsurg.org/text.asp?2011/8/1/8/78660
22. Ooms N., Matthyssens L., Draaisma J., de Blaauw I., Wijnen M. Laparoscopic treatment of intestinal malrotation in children. Eur J Pediatr Surg. 2015; 26(04): 376–81. https://www.thieme-connect.de/DOI/DOI?10.1055/s-0035-1554914
23. Reddy S., Shah R., Kulkarni D. Laparoscopic ladd’s procedure in children: challenges, results, and problems. J Indian Assoc Pediatr Surg. 2018; 23(2): 61. https://www.jiaps.com/text.asp?2018/23/2/61/228886
24. Scalabre A., Duquesne I., Deheppe J., Rossignol G., Irtan S., Arnaud A., et al. Outcomes of laparoscopic and open surgical treatment of intestinal malrotation in children. J Pediatr Surg. 2020; 55(12): 2777–82. https://doi.org/10.1016/j.jpedsurg.2020.08.014
25. Shalaby M.S., Kuti K., Walker G. Intestinal malrotation and volvulus in infants and children. BMJ. 2013; 347: f6949. https://www.bmj.com/lookup/doi/10.1136/bmj.f6949
26. Xie W., Li Z., Wang Q., et al. Laparoscopic vs open Ladd’s procedure for malrotation in neonates and infants: a propensity score matching analysis. BMC Surg 22, 25(2022). https://doi.org/10.1186/s12893-022-01487-1
27. Kubo H., Koda Y., Ishikawa Y. Intussusception following the Ladd procedure for malrotation. Pediatr Int. 2019; 61(9): 926–7.
28. Raitio A., Green P., Fawkner-Corbett D., Wilkinson D., Baillie C. Malrotation: age-related differences in reoperation rate. Eur J Pediatr Surg. 2015; 26(01): 034–7. https://www.thieme-connect.de/DOI/DOI?10.1055/s-0035-1563677
29. El-Gohary Y., Alagtal M., Gillick J. Long-term complications following operative intervention for intestinal malrotation: a 10-year review. Pediatr Surg Int. 2010; 26(2): 203–6.
30. Эргашев Н.Ш., Саттаров Ж.Б., Эргашев Б.Б. Синдром Ледда у новорождённых. Детская хирургия. 2015; 19(2): 26–9.
31. Lakshminarayanan B., Hughes-Thomas A.O., Grant H.W. Epidemiology of adhesions in infants and children following open surgery. Semin Pediatr Surg. 2014; 23(6): 344–8. https://doi.org/10.1053/j.sempedsurg.2014.06.005
32. Murphy F.L., Sparnon A.L. Long-term complications following intestinal malrotation and the Ladd’s procedure: a 15 year review. Pediatr Surg Int. 2006; 22(4): 326–9. https://doi.org/10.1007/s00383-006-1653-4
Russian Journal of Pediatric Surgery. 2023; 27: 168-175
Comparative results after the management of intestinal malrotation in newborns with laparoscopy and laparotomy
https://doi.org/10.55308/1560-9510-2023-27-3-168-175Abstract
Introduction. The open Ladd surgery is a standard treatment of intestinal malrotation. After implementing laparoscopic techniques into clinical practice, the number of reports on successful treatment of this defect with minimally invasive laparoscopic techniques is growing. However, publications on such correction of the defect in newborns are rather scarce.
Purpose. To improve management of newborns with intestinal malrotation.
Material and methods. Retrospective and prospective analyses of 77 newborns with intestinal malrotation, treated in 2002–2020, have been made. The studied group included 35 newborns; the control group – 42. StatTech program was used for statistical data processing.
Results. Groups were comparable in anthropometric indicators, gender composition, gestational age. The following differences were revealed during the study: laparoscopic surgery lasts longer than the open surgery. The intensive care period was uneventful in the studied group. Passage through the intestine was restored faster, enteral feeding started earlier in the laparoscopic group too. The number of bed days in patients operated with minimally invasive techniques was less , if to compare to the control group with open surgery. After the open surgery, children often required intestinal stimulation in order to restore passage through the gastrointestinal tract. The incidence of complications does not depend on the applied surgical technique. Relapses in both groups are comparable; the leading factor in developing relapses is violations of surgical techniques.
References
1. Stanfill A.B., Pearl R.H., Kalvakuri K., et al. Laparoscopic Ladd’s procedure: treatment of choice for midgut malrotation in infants and children.. J Laparoendosc Adv Surg Tech. 2010; 20(4): 369–72. https://doi.org/10.1089/lap.2009.01182
2. Miyano G., Fukuzawa H., Morita K., Kaneshiro M., Miyake H., Nouso H., Yamoto M., Fukumoto K., Urushihara N. Laparoscopic repair of malrotation: what are the indications in neonates and children? J Laparoendosc Adv Surg Tech A. 2015; 25(2): 155–8. https://doi.org/10.1089/lap.2014.0236
3. Zani A., Pierro A. Intestinal malrotation. In: Puri P. (ed). Newborn surgery, 4th ed. CRC Press, Boca Raton, FL (in press); 2017.
4. Lin J.N., Lou C.C., Wang K.L. Intestinal malrotation and midgut volvulus: a 15-year review. J Formos Med Assoc Taiwan yizhi. 1995; 94(4): 178–81.
5. Lampl B., Levin T.L., Berdon W.E., et al. Malrotation and midgut volvulus: a historical review and current controversies in diagnosis and management. Pediatr Radiol. 2009; 39(4): 359–66.
6. Ford E.G., Senac M.O. Jr, Srikanth M.S., Weitzman J.J. Malrotation of the intestine in children. Ann Surg. 1992; 215(2): 172–8. https://doi.org/10.1097/00000658-199202000-00013
7. Van der Zee D.C., Bax K.M.A. Laparoscopic repair of acute volvulus in a neonate with malrotation. Surg Endosc. 1995; 9(10): 1123–4. https://doi.org/10.1007/BF00189001
8. Kozlov Yu.A., Novozhilov V.A., Rasputin A.A., Us G.P., Kuznetsova N.N., Pakel'chuk A. Endokhirurgicheskoe lechenie mal'rotatsii kishechnika u novorozhdennykh i mladentsev. Khirurgiya. Zhurnal im. N.I. Pirogova. 2016; (4): 34–9. https://doi.org/10.17116/hirurgia2016434-39
9. Ferrero L., Ahmed Y.B., Philippe P., et al. Intestinal malrotation and volvulus in neonates: laparoscopy versus open laparotomy. J Laparoendosc Adv Surg Tech. 2017; 27(3): 318–21. https://doi.org/10.1089/lap.2015.0544
10. Miyano G., Fukuzawa H., Morita K., et al. Laparoscopic repair of malrotation: What are the indications in neonates and children? J Laparoendosc Adv Surg Tech. 2015; 25(2): 155–8. https://doi.org/10.1089/lap.2014.0236
11. Pham H.D., Okata Y., Vu H.M., et al. Laparoscopic Ladd’s procedure in neonates: A simple landmark detorsion technique. Pediatr Int. 2020; 62(7): 828–33. https://doi.org/10.1111/ped.14194
12. Svetanoff W.J., Sobrino J.A., Sujka J.A., St. Peter S.D., Fraser J.D. Laparoscopic Ladd procedure for the management of malrotation and volvulus. J Laparoendosc Adv Surg Tech. 2020; 30(2): 210–5. https://www.liebertpub.com/doi/10.1089/lap.2019.0602
13. Anand U., Kumar R., Priyadarshi R.N., Kumar B., Kumar S., Singh V.P. Comparative study of intestinal malrotation in infant, children, and adult in a tertiary care center in India. Indian J Gastroenterol. 2018; 37(6): 545–9. https://link.springer.com/10.1007/s12664-018-0914-1
14. Arnaud A.P., Suply E., Eaton S., Blackburn S.C., Giuliani S., Curry J.I., et al. Laparoscopic Ladd’s procedure for malrotation in infants and children is still a controversial approach. J Pediatr Surg. 2019; 54(9): 1843–7. https://doi.org/10.1016/j.jpedsurg.2018.09.023
15. Catania V.D., Lauriti G., Pierro A., Zani A. Open versus laparoscopic approach for intestinal malrotation in infants and children: a systematic review and meta-analysis. Pediatr Surg Int. 2016; 32(12): 1157–64.
16. Chacon C.S., Saxena A.K. Approach to intestinal malrotation in children in the laparoscopic era. J Pediatr Endosc Surg. 2019; (1): 137–42. https://doi.org/10.1007/s42804-019-00036-7
17. Da Costa K.M., Saxena A.K. Laparoscopic Ladd procedure for malrotation in newborns and infants. Am Surg. 2021; 87(2): 253–8.
18. Hagendoorn J., Vieira-Travassos D., Van Der Zee D. Laparoscopic treatment of intestinal malrotation in neonates and infants: Retrospective study. Surg Endosc. 2011; 25(1): 217–20.
19. Huntington J.T., Lopez J.J., Mahida J.B., Ambeba E.J., Asti L., Deans K.J., et al. Comparing laparoscopic versus open Ladd’s procedure in pediatric patients. J Pediatr Surg. 2017; 52(7): 1128–31. https://doi.org/10.1016/j.jpedsurg.2016.10.046
20. Isani M.A., Schlieve C., Jackson J., Elizee M., Asuelime G., Rosenberg D, et al. Is less more? Laparoscopic versus open Ladd’s procedure in children with malrotation. J Surg Res. 2018; 229: 351–6. https://doi.org/10.1016/j.jss.2018.04.016
21. Nasir A., Abdur-Rahman L., Adeniran J. Outcomes of surgical treatment of malrotation in children. African J Paediatr Surg. 2011; 8(1): 8. https://www.afrjpaedsurg.org/text.asp?2011/8/1/8/78660
22. Ooms N., Matthyssens L., Draaisma J., de Blaauw I., Wijnen M. Laparoscopic treatment of intestinal malrotation in children. Eur J Pediatr Surg. 2015; 26(04): 376–81. https://www.thieme-connect.de/DOI/DOI?10.1055/s-0035-1554914
23. Reddy S., Shah R., Kulkarni D. Laparoscopic ladd’s procedure in children: challenges, results, and problems. J Indian Assoc Pediatr Surg. 2018; 23(2): 61. https://www.jiaps.com/text.asp?2018/23/2/61/228886
24. Scalabre A., Duquesne I., Deheppe J., Rossignol G., Irtan S., Arnaud A., et al. Outcomes of laparoscopic and open surgical treatment of intestinal malrotation in children. J Pediatr Surg. 2020; 55(12): 2777–82. https://doi.org/10.1016/j.jpedsurg.2020.08.014
25. Shalaby M.S., Kuti K., Walker G. Intestinal malrotation and volvulus in infants and children. BMJ. 2013; 347: f6949. https://www.bmj.com/lookup/doi/10.1136/bmj.f6949
26. Xie W., Li Z., Wang Q., et al. Laparoscopic vs open Ladd’s procedure for malrotation in neonates and infants: a propensity score matching analysis. BMC Surg 22, 25(2022). https://doi.org/10.1186/s12893-022-01487-1
27. Kubo H., Koda Y., Ishikawa Y. Intussusception following the Ladd procedure for malrotation. Pediatr Int. 2019; 61(9): 926–7.
28. Raitio A., Green P., Fawkner-Corbett D., Wilkinson D., Baillie C. Malrotation: age-related differences in reoperation rate. Eur J Pediatr Surg. 2015; 26(01): 034–7. https://www.thieme-connect.de/DOI/DOI?10.1055/s-0035-1563677
29. El-Gohary Y., Alagtal M., Gillick J. Long-term complications following operative intervention for intestinal malrotation: a 10-year review. Pediatr Surg Int. 2010; 26(2): 203–6.
30. Ergashev N.Sh., Sattarov Zh.B., Ergashev B.B. Sindrom Ledda u novorozhdennykh. Detskaya khirurgiya. 2015; 19(2): 26–9.
31. Lakshminarayanan B., Hughes-Thomas A.O., Grant H.W. Epidemiology of adhesions in infants and children following open surgery. Semin Pediatr Surg. 2014; 23(6): 344–8. https://doi.org/10.1053/j.sempedsurg.2014.06.005
32. Murphy F.L., Sparnon A.L. Long-term complications following intestinal malrotation and the Ladd’s procedure: a 15 year review. Pediatr Surg Int. 2006; 22(4): 326–9. https://doi.org/10.1007/s00383-006-1653-4
