AIM:To investigate and describe our current institutional management protocol for single-ventricle patients who must undergo a Ladd's procedure.METHODS:We retrospectively reviewed the charts of all patients from J...AIM:To investigate and describe our current institutional management protocol for single-ventricle patients who must undergo a Ladd's procedure.METHODS:We retrospectively reviewed the charts of all patients from January 2005 to March 2014 who were diagnosed with heterotaxy syndrome and an associated intestinal rotation anomaly who carried a cardiac diagnosis of functional single ventricle and were status post stage I palliation.A total of 8 patients with a history of stage I single-ventricle palliation underwent Ladd's procedure during this time period.We reviewed each patients chart to determine if significant intraoperative or post-operative morbidity or mortality occurred.We also described our protocolized management of these patients in the cardiac intensive care unit,which included pre-operative labs,echocardiography,milrinone infusion,as well as protocolized fluid administration and anticoagulation regimines.We also reviewed the literature to determine the reported morbidity and mortality associated with the Ladd's procedure in this particular cardiac physiology and if other institutions have reported protocolized care of these patients.RESULTS:A total of 8 patients were identified to have heterotaxy with an intestinal rotation anomaly and single-ventricle heart disease that was status post single ventricle palliation.Six of these patients were palliated with a Blaylock-Taussig shunt,one of whom underwent a Norwood procedure.The two other patients were palliated with a stent,which was placed in the ductus arteriosus.These eight patients all underwent elective Ladd's procedure at the time of gastrostomy tube placement.Per our protocol,all patients remained on aspirin prior to surgery and had no period where they were without anticoagulation.All patients remained on milrinone during and after the procedure and received fluid administration upon arrival to the cardiac intensive care unit to account for losses.All 8 patients experienced no intraoperative or post-operative complications.All patients survived to discharge.One patient presented to the emergency room two months after discharge in cardiac arrest and died due to bowel obstruction and perforation.CONCLUSION:Protocolized intensive care management may have contributed to favorable outcomes following Ladd's procedure at our institution.展开更多
目的探讨腹腔镜与传统开腹Ladd术治疗肠旋转不良的临床效果。方法两名研究人员同时通过数据库(PubMed、Web of Science、Embase、中国知网、万方数据库、维普数据库)检索儿童腹腔镜Ladd术与开腹Ladd术的比较研究,对术后进食时间、住院...目的探讨腹腔镜与传统开腹Ladd术治疗肠旋转不良的临床效果。方法两名研究人员同时通过数据库(PubMed、Web of Science、Embase、中国知网、万方数据库、维普数据库)检索儿童腹腔镜Ladd术与开腹Ladd术的比较研究,对术后进食时间、住院时间、术后免疫功能受影响程度及术后并发症情况分析比较。筛选文献后采用Cochrane风险偏倚评估工具及纽卡斯尔-渥太华评估量表(The Newcastle-Ottawa Scale,NOS)进行文献质量评价,并提取文献数据。应用RevMan 5.3软件进行Meta分析。结果在筛选的1278篇文献中,对52篇进行了全文阅读分析,16篇符合纳入标准。共2820例肠旋转不良,其中腹腔镜Ladd术979例(腹腔镜组),开腹Ladd术1841例(开腹组)。Meta分析结果显示:与开腹组相比,腹腔镜组术后进食时间早[MD=-1.51,95%CI(-2.09,-0.93),P<0.001],住院时间短[MD=-2.63;95%CI(-3.80,-1.46),P<0.001],对免疫功能抑制程度低[MD=1.75;95%CI(1.09,2.41),P<0.001],术后粘连性肠梗阻发生率低[RR=0.70,95%CI(0.51,0.96),P=0.03],术后切口感染率低[RR=0.44,95%CI(0.24,0.80),P=0.007],术后切口裂开率低[RR=0.33;95%CI(0.13,0.81),P=0.02]。但手术时间[MD=0.66,95%CI(-16.35,17.67),P=0.94]和术后肠扭转发生率[RR=1.17,95%CI(0.63,2.17),P=0.62]在两组间差异无统计学意义。结论腹腔镜Ladd术较开腹Ladd术治疗婴儿及儿童先天性肠旋转不良具有术后恢复快、对免疫功能抑制程度低、并发症少的优势。展开更多
文摘AIM:To investigate and describe our current institutional management protocol for single-ventricle patients who must undergo a Ladd's procedure.METHODS:We retrospectively reviewed the charts of all patients from January 2005 to March 2014 who were diagnosed with heterotaxy syndrome and an associated intestinal rotation anomaly who carried a cardiac diagnosis of functional single ventricle and were status post stage I palliation.A total of 8 patients with a history of stage I single-ventricle palliation underwent Ladd's procedure during this time period.We reviewed each patients chart to determine if significant intraoperative or post-operative morbidity or mortality occurred.We also described our protocolized management of these patients in the cardiac intensive care unit,which included pre-operative labs,echocardiography,milrinone infusion,as well as protocolized fluid administration and anticoagulation regimines.We also reviewed the literature to determine the reported morbidity and mortality associated with the Ladd's procedure in this particular cardiac physiology and if other institutions have reported protocolized care of these patients.RESULTS:A total of 8 patients were identified to have heterotaxy with an intestinal rotation anomaly and single-ventricle heart disease that was status post single ventricle palliation.Six of these patients were palliated with a Blaylock-Taussig shunt,one of whom underwent a Norwood procedure.The two other patients were palliated with a stent,which was placed in the ductus arteriosus.These eight patients all underwent elective Ladd's procedure at the time of gastrostomy tube placement.Per our protocol,all patients remained on aspirin prior to surgery and had no period where they were without anticoagulation.All patients remained on milrinone during and after the procedure and received fluid administration upon arrival to the cardiac intensive care unit to account for losses.All 8 patients experienced no intraoperative or post-operative complications.All patients survived to discharge.One patient presented to the emergency room two months after discharge in cardiac arrest and died due to bowel obstruction and perforation.CONCLUSION:Protocolized intensive care management may have contributed to favorable outcomes following Ladd's procedure at our institution.
