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Laparoscopic Treatment of Acute Volvulus in Children (Abstract)

C. Zamfir, H. Allal
Montpellier, France

 

ABSTRACT

Propose: To assess the feasibility of a laparoscopic procedure in the treatment of acute volvulus in children.

Material and methods: From 1992 to 2002 in our institution, 6 children underwent a laparoscopic Ladd’s procedure for acute volvulus of the midgut. The age ranged between 3 days to 1 month. All patients have been hospitalised as an emergency for bilious vomiting or acute occlusive syndrome. Ultrasound study confirmed the diagnosis of midgut volvulus without any delay in all the cases. Laparoscopic procedure was started immediately, using a 5 mm scope (open introduction) and 3 operating trocars of 3 mm each (left and right mid quadrants and the third one in the epigastric area). The pressure of CO inflation was 8 mm Hg at a debit of 6l/min. A standard Ladd’s procedure with appendectomy was performed in all cases.

Results: The first 2 from the 6 procedures were converted into open surgery because of inappropriate material and the lack of experience of the surgeon. No intraoperative complications occurred since. However one of the 4 other patients had to be reoperated at day 5, because of persistence of bilious vomiting and difficulties in oral feeding. An open procedure was performed for a probable recurrence of volvulus. In fact there was no volvulus, only a persistent duodenal stricture but not a Ladd one. This case is the only one with a long hospital stay (one month). The other 3 had a smooth post operative course with no recurrence of symptoms. The oral intake was started at day 2 or 3 and they have been discharged between day 5 and 9. The follow up is from 1 to 10 years with a good clinical evolution.

Conclusions: Laparoscopic Ladd’s procedure could be an interesting option for the treatment of acute volvulus of the midgut in children. It must be performed only by experimented surgeons in the neonatal laparoscopic field and with adapted instruments for the size of the baby. The advantages are less postoperative pain, an earlier enteral feeding and less scaring.

Key words: acute midgut volvulus, laparoscopic treatment 

 

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