Screening and Treatment of Intestinal Rotational Abnormalities in Heterotaxy: A Systematic Review and Meta-Analysis

J Pediatr. 2016 Apr;171:153-62.e1-3. doi: 10.1016/j.jpeds.2015.12.074. Epub 2016 Feb 8.

Abstract

Objective: To assess the role of screening and prophylactic surgery for intestinal rotational abnormalities (IRAs) in asymptomatic patients with heterotaxy.

Study design: PubMed, Embase, and Cinahl were searched electronically to determine the overall incidence of IRAs in heterotaxy; the detection rate of IRAs associated with screening; the incidence of midgut volvulus in patients without screening; and the incidence of morbidity and mortality after prophylactic and emergency Ladd procedures. Relevant data were computed with a meta-analysis of proportions. Between-study heterogeneity was assessed with the I(2) statistic.

Results: From 276 papers identified, 24 studies with a total of 1433 patients with heterotaxy were included for systematic review. No randomized study was identified. True incidence of IRA in heterotaxy could not be ascertained through meta-analysis. In patients who underwent screening, the incidence of IRA was 58%. Acute midgut volvulus occurred in 5.8% of those who did not undergo screening. Postoperative mortality after Ladd procedure mainly was associated with cardiac insufficiency, and overall it was significantly greater in the emergency group compared with the prophylactic group (18% vs 5.6%). The complication rate also was greater in case of emergency vs prophylactic abdominal surgery (27% vs 16%); adhesional small bowel obstruction was the most common complication overall (6%).

Conclusion: The screen-detected incidences of IRA and acute midgut volvulus were significantly greater in heterotaxy than the normal population. Prophylactic Ladd procedure was associated with less morbidity and mortality compared with emergency surgery. A long-term prospective randomized trial is needed to define the indication for screening and prophylactic treatment of IRA in heterotaxy.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Digestive System Abnormalities / diagnosis*
  • Digestive System Abnormalities / epidemiology
  • Digestive System Abnormalities / surgery*
  • Digestive System Surgical Procedures / adverse effects
  • Digestive System Surgical Procedures / methods
  • Heterotaxy Syndrome / diagnosis*
  • Heterotaxy Syndrome / epidemiology
  • Heterotaxy Syndrome / surgery*
  • Humans
  • Incidence
  • Intestinal Volvulus / diagnosis*
  • Intestinal Volvulus / epidemiology
  • Intestinal Volvulus / surgery*
  • Intestines / abnormalities*
  • Mass Screening / methods*
  • Postoperative Complications
  • Postoperative Period
  • Rotation

Supplementary concepts

  • Volvulus Of Midgut