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<p><b>OBJECTIVE</b>To analyze complications after laparoscopic Ladd operation for intestinal malrotation, related causes and possible solutions.</p><p><b>METHODS</b>Clinical data of 81 neonates who underwent laparoscopic Ladd operations for intestinal malrotation in the Children's Hospital, Zhejiang University School of Medicine between January 2015 and January 2018 were reviewed. The abdominal complications and findings during operation and reoperation were analyzed.</p><p><b>RESULTS</b>Operations were successfully completed in all patients, and there was no patient converted to open surgery. The annular pancreas in 6 cases and duodenal diaphragm in 4 cases were confirmed during the operation. The recurrent volvulus developed in 3 patients (3.7%), of whom 2 cases were confirmed to have midgut necrosis during open surgery 1 week and 3 months after laparoscopic Ladd operation, and both finally died; 1 case was corrected by second laparoscopic operation. Cecal perforation occurred in 1 patient (1.2%), which was caused by intensive high frequency coagulation of the appendiceal stump. One patient (1.2%) developed chylous ascites and improved after conservative treatment. Adhesive small bowel obstruction was observed in 3 cases (3.7%), and all relieved after conservative treatment.</p><p><b>CONCLUSIONS</b>Laparoscopic Ladd operation for intestinal malrotation in neonates was effective, and the incidence of abdominal complications may be minimized by experienced skills and strict perioperative management.</p>
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Objective To evaluate the efficacy of single or double-antibiotic regimen for the treatment of complicated appendicitis in children,with the purpose to guide the rational use of antibiotics in clinic.Methods Six hundred and sixty-three patients with acute appendicitis admitted to the department of pediatric surgery in Jinhua Municipal Central Hospital between March 2011 and February 2015.One hundred and seventy-two of 663 patients with complicated appendicitis which confirmed by intra-operative macroscopic or post-operative pathological examination were eligible for the study.These patients were divided into two groups based on the regimen of their postoperative antibiotics:single or double-antibiotic regimen(treatment group,n=66);triple antibiotics regimen(control group,n=106).Demographic data,blood routine test and C-response protein(CRP),length of hospital stay,postoperative complications and duration of antibiotic treatment were recorded and statistically analyzed.Results There was no difference between the treatment group and control group with respect to age distribution,blood routine examination and CRP, length of hospital stay, duration of antibiotic treatment or postoperative complications.Although the number of patients changed of antibiotics on the basis of bacterial culture of pyogenic fluids in treatment group were more frequently than those in the control group(7/66 vs.1/106), the therapeutic effective rate of changed of antibiotics was 100% in both two groups.The culture positive rate of peritoneal fluids was 72.09% (124/172), the most common pathogens were escherichia coli(80.15%, 105/131),pseudomonas aeruginosa(5.34%,7/131)and klebsiella pneumonia (3.05%,4/131).The results of bacterial culture of peogenic fluids showed no difference in both two groups.Conclusion Children with complicated appendicitis can be managed effectively with single or double broad-spectrum antibiotics after appendectomy,and it may be beneficial to guide the rational use of antibiotics and decrease the irrational use of multi-antibiotics combination in clinic.