Effect of Adhesion Barrier Use During Ladd Procedure for Intestinal Malrotation on Postoperative Midgut Volvulus and Postoperative Small-Bowel Obstruction: A Retrospective Cohort Study Using a National Inpatient Database

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported in abstract

• Effect Size: Risk difference for midgut volvulus: 0.8% (95% CI -1.9 to 3.5); Risk difference for small-bowel obstruction rehospitalization: -3.6% (95% CI -6.6 to -0.8)

• Primary Outcome: No significant difference in reoperation for midgut volvulus between groups (3.5% vs 2.7%)

• Nnt Or Sensitivity: Number needed to treat to prevent one small-bowel obstruction rehospitalization: approximately 28 patients

• Confidence Interval: 95% CI for small-bowel obstruction: -6.6% to -0.8%

Clinical Application

Adhesion barriers are readily available in Australian pediatric surgical units, though cost considerations may apply Results relevant to Australian pediatric surgery practice; adhesion barriers available through hospital procurement, not PBS-listed. Aligns with RACS pediatric surgery guidelines emphasizing complication prevention Pediatric patients undergoing Ladd procedure for intestinal malrotation in tertiary pediatric surgical centers

Abstract

BACKGROUND: Postoperative midgut volvulus is a life-threatening complication after the Ladd procedure. An adhesion barrier to prevent postoperative small-bowel obstruction could increase postoperative midgut volvulus incidence due to reduced adhesions. We aimed to examine the effect of adhesion barrier use during Ladd procedures on postoperative midgut volvulus and postoperative small-bowel obstruction. STUDY DESIGN: We retrospectively identified patients younger than 18 years who underwent the Ladd procedure between July 2010 and March 2021, using a Japanese nationwide inpatient database. We used propensity score overlap-weighting analyses to compare reoperation for midgut volvulus, rehospitalization, and operation for small-bowel obstruction, mortality, total rehospitalization length, and total rehospitalization cost within 1 year after the Ladd procedure between patients in whom adhesion barrier was used (barrier group) and patients in whom it was not used (nonbarrier group). RESULTS: Of the 1,159 eligible patients, adhesion barrier was used in 314 and not used in 845 patients. The proportion of reoperations for midgut volvulus did not differ between the barrier and nonbarrier groups (3.5% vs 2.7%; risk difference 0.8%, 95% CI -1.9 to 3.5). The proportion of rehospitalization due to small-bowel obstruction was lower in the barrier group than in the nonbarrier group (2.6% vs 6.3%; risk difference -3.6%, 95% CI -6.6 to -0.8). No significant differences were observed in operation for small-bowel obstruction, mortality, and total length and cost of rehospitalization. CONCLUSIONS: The use of adhesion barrier during the Ladd procedure can prevent rehospitalization due to postoperative small-bowel obstruction without increasing the incidence of postoperative midgut volvulus.

References

1. 1.Takamoto, N., Aso, S., Konishi, T., Fujiogi, M., Kutsukake, M., Yanagida, Y., Matsui, H., Fushimi, K., Yasunaga, H., & Fujishiro, J. (2026). Effect of Adhesion Barrier Use During Ladd Procedure for Intestinal Malrotation on Postoperative Midgut Volvulus and Postoperative Small-Bowel Obstruction: A Retrospective Cohort Study Using a National Inpatient Database. Journal of the American College of Surgeons. https://doi.org/10.1097/XCS.0000000000001693