The Learning Curve of Laparoscopic Ladd’s Operation in the Treatment of Children with Intestinal Malrotation

The purpose of this study was to explore the learning curve of pediatric surgeons with a skilled laparoscopic basis for laparoscopic Ladd’s procedure to treat children with intestinal malrotation. From April 2015 to February 2020, a total of 35 consecutive children who underwent laparoscopic Ladd’s procedure for intestinal malrotation performed by the same surgeon were included in this study. The learning curve was analyzed using the cumulative sum (CUSUM) method. This method was used for all 35 cases, taking into account operation time, estimated blood loss, time to start eating after operation, postoperative hospital stay, and postoperative complication rate. All 35 children completed the Ladd’s procedure through laparoscopy, and there was no transfer to opening. The CUSUM learning curve was best modeled as a polynomial with equation y=1.1842+1.8625x−0.0365x²−0.0006x³, with goodness-of-fit (R²) as 0.987. The fitting curve slope turned into negative at the 17th case, and the learning curves were divided into learning stage (phase I, case number 1–17, n=17) and mastery stage (phase II, case number 18–35, n=18) with 17 cases as the cutoff point. The operation time, estimated blood loss, time to start eating after operation, and postoperative complication rate in phase II were significantly better than that in phase I, and the difference was statistically significant (all P<0.05). For pediatric surgeons with skilled laparoscopic basis, the learning curve of laparoscopic Ladd’s procedure for children with intestinal malrotation was 17 cases.