Comparing laparoscopic versus open elective Ladd procedures in pediatric patients: A 10-year review of the NSQIP-Pediatric Database

Purpose: To investigate changes in the proportion of Ladd procedures being performed laparoscopically over time and compare 30-day outcomes between laparoscopic and open Ladd. Methods: Patients <18 years who underwent an elective Ladd procedure between 2013 and 2022 in the National Surgical Quality Improvement Program (NSQIP)-Pediatric database were included. Changes in the proportion of patients undergoing a laparoscopic approach over time were evaluated overall and in subgroups (age <1 and ≥1 year) using Cochran–Armitage tests. Comparison of 30-day outcomes between laparoscopic and open Ladd were performed using propensity score matched (PSM) cohorts. Results: Of the 1563 included patients, 66% had an open procedure and 34% a laparoscopic procedure. The proportion of patients undergoing laparoscopic Ladd significantly increased from 24% in 2013 to 40% in 2022 (p < 0.0001), similar increases were seen in patients ≥1 year and <1 year of age. After PSM, median post-operative length of stay was longer in the open group [6 days, interquartile range (IQR) 3–11 vs. 3 days, IQR 2–7, p < 0.0001]. Patients who underwent an open Ladd were more likely to require a transfusion post-operatively (6.0% vs. 1.8%, p = 0.003). Conclusions: Elective Ladd procedures being performed laparoscopically has increased over time across all pediatric age groups. In a matched cohort, laparoscopic Ladd is associated with decreased length of stay and lower risk of transfusion requirements. The increased use of laparoscopic Ladd warrants additional rigorous investigation to compare longer term outcomes.