Laparoscopic Ladd’s Procedure Associated With Fewer Reoperations for Small Bowel Obstruction

A multicenter retrospective cohort published in the Journal of the American College of Surgeons evaluated whether operative approach was associated with reoperation after Ladd’s procedure. Researchers included 697 patients aged 15 years or younger treated at 10 children’s hospitals between January 2014 and September 2021, comparing postoperative outcomes within three years.

Of these patients, 495 underwent open surgery and 202 underwent a laparoscopic approach; 72 laparoscopic cases (35.6%) were converted to open. Reoperation for postoperative small bowel obstruction occurred in 6.7% of open cases versus 1.5% of laparoscopic cases (p=0.017). Laparoscopy was associated with lower adjusted odds of this outcome (OR 0.216; 95% CI 0.050–0.934; p=0.040). Reoperation for postoperative volvulus occurred in 2.2% overall, with no difference detected by approach.

The findings suggest a potential advantage for laparoscopy regarding obstruction-related reoperation, but do not establish causality. Patients undergoing open surgery were younger, with reported ages of 1.7 versus 9.5 months, and more frequently had volvulus (31.0% versus 9.2%) and bowel resection (7.2% versus 0%). These baseline differences, the retrospective design, and frequent conversion to open surgery complicate comparisons. The endpoints measured reoperations rather than all postoperative obstruction or volvulus events.