Preemptive Ladd Procedure in congenital diaphragmatic hernia and Abdominal Wall defects does not reduce the risk of future volvulus
| Autor: | Karen Kling, Stephen W. Bickler, Andrew W. Wang, Erin Ward, Hari Thangarajah, Timothy J. Fairbanks, David A. Lazar |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Asymptomatic Abdominal wall 03 medical and health sciences 0302 clinical medicine 030225 pediatrics parasitic diseases medicine Humans In patient Retrospective Studies Gastroschisis Omphalocele business.industry Abdominal Wall Infant Newborn Infant Congenital diaphragmatic hernia General Medicine medicine.disease Surgery Volvulus medicine.anatomical_structure Increased risk 030220 oncology & carcinogenesis Pediatrics Perinatology and Child Health Female medicine.symptom Hernias Diaphragmatic Congenital business Digestive System Abnormalities Hernia Umbilical Intestinal Volvulus |
| Zdroj: | Journal of Pediatric Surgery. 52:1956-1961 |
| ISSN: | 0022-3468 |
| Popis: | Patients with congenital diaphragmatic hernia (CDH), gastroschisis, and omphalocele are prone to abnormalities of intestinal rotation and thus future midgut volvulus. Controversy exists whether routine preemptive Ladd procedure in this subgroup of asymptomatic patients is of value to reduce future volvulus.The Pediatric Health Information System (PHIS) database was queried for neonates with CDH, gastroschisis, and omphalocele between January 2009 and September 2015. Standard univariate and multivariate analysis was completed to compare risk of volvulus between patients treated with a preemptive Ladd versus no Ladd (p0.05).Seven thousand seven hundred forty-nine neonates with CDH (40%), gastroschisis (38%), omphalocele (14%), and abdominal wall malformation (NOS) (9%) were identified. Overall, 3.6% (n=279) had a preemptive. Thirty-two patients had subsequent volvulus. Ladd procedure did not reduce volvulus readmissions for any diagnosis and was associated with a significantly increased risk of volvulus for omphalocele patients (9.1% vs 0.1%, p0.001). Overall, a Ladd procedure during the index admission was associated with a higher risk for volvulus (1.4% vs. 0.4%, p=0.021) and was associated with a 3.28 increased odds ratio of future volvulus (95% CI 1.12-9.68).Ladd procedure performed prophylactically in patients with CDH, gastroschisis, and omphalocele did not reduce subsequent volvulus.III, Retrospective Comparative Study. |
| Databáze: | OpenAIRE |
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