Laparoscopic Vs Open Ladd’s Procedure for Intestinal Malrotation in Infants and Children: A Systematic Review and Meta-Analysis

Purpose This study aimed to compare the outcomes of laparoscopic Ladd’s procedure (LL) and open Ladd’s procedure (OL) for the treatment of intestinal malrotation in infants and children, focusing on operative parameters, postoperative recovery, and complications through a systematic review and meta-analysis. Methods A comprehensive literature search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted up to June 2025 following PRISMA guidelines. Studies comparing LL and OL in pediatric patients (<18 years) were included. Data were analyzed using Review Manager 5.4. Mean differences (MD) and odds ratios (OR) with 95% confidence intervals (CI) were calculated using fixed- or random-effects models depending on heterogeneity. Results Eighteen studies including 3479 patients (LL: 928; OL: 2551) met the inclusion criteria. There was no significant difference in operative time between LL and OL (MD = 9.14, 95% CI: −4.01–22.28; P = 0.17). However, LL showed shorter time to full intake (MD = −2.64 days; P < 0.001) and shorter hospital stay (MD = −3.19 days; P < 0.001). LL was associated with lower rates of adhesive bowel obstruction (OR = 0.44; P < 0.001) and overall complications (OR = 0.39; P < 0.001), but higher rates of postoperative volvulus (OR = 3.26; P = 0.002) and reoperation (OR = 1.67; P = 0.03). Conclusions Laparoscopic Ladd’s procedure offers advantages in postoperative recovery and reduced complication rates compared with the open approach, though it may carry a higher risk of volvulus and reoperation.