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

详细信息    查看全文

• 作者：Yew-Wei Tan ; FRCS (Ped Surg)¹ ; Asma Khalil ; MRCOG ; MSc (Epi)² ; Madhavi Kakade ; FRCS (Ped Surg)³ ; Julene S. Carvalho ; MD ; PhD ; FRCPCH² ; ⁴ ; Sarah Bradley ; RGN ; ANNP ; MSc¹ ; Stewart Cleeve ; FRCS (Ped Surg)⁵ ; Stefano Giuliani ; FRCS (Eng) ; MD ; PhD¹ ; ^{Stefano.giuliani@nhs.net" class="auth_mail" title="E-mail the corresponding author}
• 关键词：IRA ; Intestinal rotational abnormality ; NOS ; Newcastle-Ottawa Scale
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：171
• 期：Complete
• 页码：153-162.e3
• 全文大小：1608 K

文摘

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 I² 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.