Abstract
Gastroschisis is known to be associated with abnormal bowel rotation. Currently, the
broadly accepted practice is not to perform Ladd’s procedure routinely at the time
of closure of gastroschisis defects. However the incidence of symptomatic malrotation
and volvulus post gastroschisis repair is unknown; this incidence is important in
view of the current practice of bedside gastroschisis closure. This study examined
the incidence of symptomatic malrotation and volvulus following gastroschisis repair.
Method:
Patients who had undergone gastroschisis repair between 1999 and 2009 in any of 2
tertiary centers were identified using the Hospital Inpatient Enquiry system. The
medical records were reviewed to obtain demographic data and postoperative outcomes.
Patients were contacted for follow-up.
Results:
128 patients were identified with a median postoperative follow-up of 4 years (range:
6 weeks to 12 years). Upper gastrointestinal (GI) contrast studies were performed
in 30 patients (23.4%), 21 (16.4%) of whom showed evidence of malrotation. Malrotation
was documented during the primary repair in 12 patients (9.4%); however Ladd’s procedure
was performed primarily in only 3 patients. 7 patients underwent Ladd’s procedure
in a second laparotomy for mechanical obstruction secondary to causes not related
to malrotation and volvulus. A total of 29 patients (22.7%) had either operative or
radiological evidence of malrotation. None of these patients developed volvulus after
being followed for a median period of 4 years.
Conclusion:
Bedside gastroschisis closure without concomitant Ladd’s procedure is a safe practice.
None of the patients with documented malrotation developed volvulus post gastroschisis
repair.
Key words
gastroschisis - malrotation - volvulus
