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Background <p>Adult intestinal malrotation is rare, and data comparing minimally invasive surgery (MIS) to open Ladd’s procedures in this population are limited. This study evaluates perioperative outcomes and MIS utilization in adults.</p> Methods <p>A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) 2022–2023 datasets identified adults undergoing Ladd’s procedure. The primary outcome was total hospital length of stay (tLOS); secondary outcomes included postoperative LOS (pLOS), 30-day morbidity, and mortality. Multivariable linear and logistic regression identified independent predictors of LOS and MIS utilization.</p> Results <p>Of 142 Ladd’s procedures identified in adult patients (109 open, 33 MIS), MIS patients were younger (mean age 47.0 vs. 58.2&#xa0;years, p = 0.005), more often female (78.8% vs. 53.2%, p = 0.014), and more likely undergoing elective surgery (51.6% vs. 24.8%, p = 0.005). Total LOS (3.12 vs. 7.89&#xa0;days, p &lt; 0.001) and pLOS (2.45 vs. 6.81&#xa0;days, p &lt; 0.001) were significantly shorter in the MIS cohort. 30-day morbidity and mortality were similar. Multivariable linear regression showed MIS approach (B = −&#xa0;0.871, 95% CI −&#xa0;1.137, −&#xa0;0.604, p &lt; 0.001), higher ASA class (B = 0.347, 95% CI 0.068, 0.627, p = 0.015), and days from admission to surgery (B = 0.180, 95% CI 0.119, 0.240, p &lt; 0.001) independently predicted tLOS. These represent a 58.1% reduction in tLOS for MIS approach, 41.5% increase for higher ASA class, and 19.6% increase per day of surgical delay. MIS approach (B = −&#xa0;0.893, p &lt; 0.001) and higher ASA class (B = 0.395, p = 0.012) independently predicted pLOS, representing 59.1% reduction and 48% increase, respectively. Younger age (OR 0.97, p = 0.040) and elective surgery (OR 0.33, p = 0.024) independently predicted MIS utilization.</p> Conclusions <p>MIS Ladd’s procedures in adults were associated with significantly shorter hospital stays without an associated increase in 30-day morbidity or mortality. For those undergoing elective Ladds procedure for malrotation without volvulus, MIS Ladd’s appears to be a viable surgical approach to consider.</p>

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The safety and feasibility of minimally invasive Ladd’s procedures in adult patients: a NSQIP analysis

  • 期刊论文

  • 发表日期：

    2026年4月24日

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  • Michael Wang,
  • Emily Hancin,
  • Penghao Wang,
  • Emma Dragan,
  • Ami Kalola,
  • Nadine Barth,
  • Keshav Kooragayala

摘要

Background

Adult intestinal malrotation is rare, and data comparing minimally invasive surgery (MIS) to open Ladd’s procedures in this population are limited. This study evaluates perioperative outcomes and MIS utilization in adults.

Methods

A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) 2022–2023 datasets identified adults undergoing Ladd’s procedure. The primary outcome was total hospital length of stay (tLOS); secondary outcomes included postoperative LOS (pLOS), 30-day morbidity, and mortality. Multivariable linear and logistic regression identified independent predictors of LOS and MIS utilization.

Results

Of 142 Ladd’s procedures identified in adult patients (109 open, 33 MIS), MIS patients were younger (mean age 47.0 vs. 58.2 years, p = 0.005), more often female (78.8% vs. 53.2%, p = 0.014), and more likely undergoing elective surgery (51.6% vs. 24.8%, p = 0.005). Total LOS (3.12 vs. 7.89 days, p < 0.001) and pLOS (2.45 vs. 6.81 days, p < 0.001) were significantly shorter in the MIS cohort. 30-day morbidity and mortality were similar. Multivariable linear regression showed MIS approach (B = − 0.871, 95% CI − 1.137, − 0.604, p < 0.001), higher ASA class (B = 0.347, 95% CI 0.068, 0.627, p = 0.015), and days from admission to surgery (B = 0.180, 95% CI 0.119, 0.240, p < 0.001) independently predicted tLOS. These represent a 58.1% reduction in tLOS for MIS approach, 41.5% increase for higher ASA class, and 19.6% increase per day of surgical delay. MIS approach (B = − 0.893, p < 0.001) and higher ASA class (B = 0.395, p = 0.012) independently predicted pLOS, representing 59.1% reduction and 48% increase, respectively. Younger age (OR 0.97, p = 0.040) and elective surgery (OR 0.33, p = 0.024) independently predicted MIS utilization.

Conclusions

MIS Ladd’s procedures in adults were associated with significantly shorter hospital stays without an associated increase in 30-day morbidity or mortality. For those undergoing elective Ladds procedure for malrotation without volvulus, MIS Ladd’s appears to be a viable surgical approach to consider.