Laparoscopic vs Open Ladd’s Procedure: A Multicenter Study of Postoperative Volvulus and Small Bowel Obstruction Rate

BACKGROUND: Whether operative approach influences reoperation for postoperative volvulus or small bowel obstruction (SBO) after Ladd's procedure remains uncertain, with limited contemporary multicenter data outside administrative databases. We evaluated whether open vs laparoscopic Ladd's procedure was associated with differences in reoperation for postoperative volvulus and SBO. STUDY DESIGN: This multicenter retrospective cohort included patients ≤15 years of age undergoing Ladd's procedure from January 2014 through September 2021 across 10 children's hospitals. Demographic, clinical, perioperative, and postoperative outcomes within 3 years were compared by operative approach. A multivariable logistic model assessed predictors of reoperation for postoperative SBO. RESULTS: Among 697 patients, 495 (71.0%) underwent open and 202 (29.0%) laparoscopic Ladd's procedure; 72 laparoscopic cases (35.6%) were converted to open. Open patients were younger (1.7 months [IQR 0.2, 12.0] vs 9.5 months [IQR 2.0, 60.0], p<0.001) and more frequently had volvulus (31.0% vs 9.2%, p<0.001) and bowel resection (7.2% vs 0.0%, p=0.002). Reoperation for postoperative volvulus was uncommon (2.2%) and did not differ by approach. Reoperation for SBO was more frequent after open Ladd's (6.7% vs 1.5%, p=0.017). Laparoscopic approach was associated with lower adjusted odds of reoperation for SBO (OR 0.216 [95% CI 0.050, 0.934], p=0.040). CONCLUSIONS: Reoperation for postoperative volvulus was uncommon and did not differ by operative approach. Laparoscopic Ladd's procedure was associated with lower reoperation for postoperative SBO compared with open operation.