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Malrotation Correction in the Adult Population

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Abstract

Background

Malrotation is a congenital anomaly most often affecting the pediatric population. The Ladd procedure is the standard treatment for this pathology. Well-studied in the pediatric population, large studies of the demographics and outcomes of patients who reach adulthood are lacking.

Methods

An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2015–2018) was performed, capturing patients with a post-operative diagnosis of malrotation and who underwent surgical correction with or without appendectomy, excluding those who underwent other major procedures such as colectomy. Baseline demographics and outcomes were compared. The primary outcome was mortality. Secondary outcomes such as length of stay and discharge destination were included.

Results

Two hundred twenty patients undergoing surgical correction of malrotation were captured, all of which were performed by a general surgeon under general anesthesia. One hundered and nine (49.55%) of these patients also underwent an appendectomy. Most of these patients were female (68.18%). Comorbidities and perioperative variables were clinically similar. Operative time was similar between the two groups (112 ± 86 vs. 98 ± 49 min, p = 0.1385). Thirty-day mortality (1.36%), length of stay (4.79 ± 6.21 days), readmission rate (13.64%), wound infection (2.27%) and discharge destination (95.00% to home) were statistically similar between groups.

Conclusions

The data describes demographics and outcomes in adults undergoing Ladd procedures with and without appendectomy. Immediate outcomes may be equivalent regardless of incidental appendectomy. Further work is necessary to describe the population of adults with malrotation reaching adulthood.

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Acknowledgements

The authors would like to acknowledge Wolters Kluwer Health for allowing us use of Fig. 1, from “Mulholland, MW; Lillemoe, KD; Doherty, GM; Upchurch, GR; Alam, HB; Pawlik, TM; Fischer, HR. Greenfield’s Surgery: Principles and Practice, Sixth Edition, Chapter 103, Image 30, Copyright 2017 Wolters Kluwer.” “American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.”

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No funding was used.

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Authors and Affiliations

  1. Department of Surgery, The University of Kansas, 4000 Cambridge, M/S 2005, Kansas City, KS, 66160, USA

    Joseph G. Brungardt, Sean C. Liebscher & Kurt P. Schropp

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  1. Joseph G. Brungardt
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  2. Sean C. Liebscher
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  3. Kurt P. Schropp
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Contributions

JGB helped in study conception and design. JGB, SCL, and KPS contributed to analysis and interpretation of data, drafting of manuscript and critical revision.

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Correspondence to Joseph G. Brungardt.

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Brungardt, J.G., Liebscher, S.C. & Schropp, K.P. Malrotation Correction in the Adult Population. World J Surg 45, 141–147 (2021). https://doi.org/10.1007/s00268-020-05790-x

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