Title: Laparoscopic Ladd’s procedure for intestinal malrotation in small infants with midterm
follow-up
Version: 1 Date: 07 Jul 2023
Reviewer's report:
This is a report comparing the outcomes of laparoscopic surgery and open surgery for infants
with malrotation of the intestines. The report specifically focuses on the laparoscopic Ladd
procedure, which is generally considered challenging in young children. The study found that
the hospitalization period was significantly shorter in the laparoscopic group compared to the
open surgery group, etc.…, indicating the advantages of laparoscopy.
The paper is logically structured and presents information clearly. As the authors suggest,
proficiency in laparoscopic techniques is necessary. However, if that proficiency can be
achieved, I understand the authors' viewpoint that this procedure could become a feasible option.
Please answer some my questions.
Major points
1. How was the selection made between laparoscopic and open surgery? There is a possibility of
bias, such as selecting cases with lower risk for laparoscopy or a concentration of laparoscopic
surgeries in the later period of the observation period. As this is a retrospective study, some
degree of bias is inevitable, but additional information regarding the selection criteria for each
group would be necessary.
2. Despite approximately 70% of cases involving midgut volvulus, the study excluded cases that
underwent emergency Ladd procedure. Is it possible that not all cases with midgut volvulus at
the authors' institution underwent emergency Ladd procedure? It would be helpful to provide
clarification on the differences between included and excluded cases in the study.
3. It seems that the reasons for performing surgery other than midgut volvulus were associated
anomalies. It would be beneficial to provide specific details in the Results regarding these
associated anomalies (ex. Duodenum atresia).
4. Although it is mentioned that two cases in the laparoscopic Ladd (LL) group were converted
to open surgery due to intraoperative bleeding and intestinal swelling, it would be helpful to
have additional information about the age of the cases and the presence of midgut volvulus. It
would be valuable to discuss the factors that make laparoscopic surgery difficult or unsuitable
in certain cases and explore the considerations surrounding this aspect.
Minor point
1. It appears that bowel fixation was not performed. It might be worth adding a section on surgical
techniques to mention that bowel fixation was not performed.
Title: Laparoscopic Ladd’s procedure for intestinal malrotation in small infants with midterm
follow-up
Version: 1 Date: 07 Jul 2023
Reviewer's report:
This is a report comparing the outcomes of laparoscopic surgery and open surgery for infants
with malrotation of the intestines. The report specifically focuses on the laparoscopic Ladd
procedure, which is generally considered challenging in young children. The study found that
the hospitalization period was significantly shorter in the laparoscopic group compared to the
open surgery group, etc.…, indicating the advantages of laparoscopy.
The paper is logically structured and presents information clearly. As the authors suggest,
proficiency in laparoscopic techniques is necessary. However, if that proficiency can be
achieved, I understand the authors' viewpoint that this procedure could become a feasible option.
Please answer some my questions.
Major points
1. How was the selection made between laparoscopic and open surgery? There is a possibility of
bias, such as selecting cases with lower risk for laparoscopy or a concentration of laparoscopic
surgeries in the later period of the observation period. As this is a retrospective study, some
degree of bias is inevitable, but additional information regarding the selection criteria for each
group would be necessary.
2. Despite approximately 70% of cases involving midgut volvulus, the study excluded cases that
underwent emergency Ladd procedure. Is it possible that not all cases with midgut volvulus at
the authors' institution underwent emergency Ladd procedure? It would be helpful to provide
clarification on the differences between included and excluded cases in the study.
3. It seems that the reasons for performing surgery other than midgut volvulus were associated
anomalies. It would be beneficial to provide specific details in the Results regarding these
associated anomalies (ex. Duodenum atresia).
4. Although it is mentioned that two cases in the laparoscopic Ladd (LL) group were converted
to open surgery due to intraoperative bleeding and intestinal swelling, it would be helpful to
have additional information about the age of the cases and the presence of midgut volvulus. It
would be valuable to discuss the factors that make laparoscopic surgery difficult or unsuitable
in certain cases and explore the considerations surrounding this aspect.
Minor point
1. It appears that bowel fixation was not performed. It might be worth adding a section on surgical
techniques to mention that bowel fixation was not performed.
Please review this paper.
user
Title: Laparoscopic Ladd’s procedure for intestinal malrotation in small infants with midterm
follow-up
Version: 1 Date: 07 Jul 2023
Reviewer's report:
This is a report comparing the outcomes of laparoscopic surgery and open surgery for infants
with malrotation of the intestines. The report specifically focuses on the laparoscopic Ladd
procedure, which is generally considered challenging in young children. The study found that
the hospitalization period was significantly shorter in the laparoscopic group compared to the
open surgery group, etc.…, indicating the advantages of laparoscopy.
The paper is logically structured and presents information clearly. As the authors suggest,
proficiency in laparoscopic techniques is necessary. However, if that proficiency can be
achieved, I understand the authors' viewpoint that this procedure could become a feasible option.
Please answer some my questions.
Major points
1. How was the selection made between laparoscopic and open surgery? There is a possibility of
bias, such as selecting cases with lower risk for laparoscopy or a concentration of laparoscopic
surgeries in the later period of the observation period. As this is a retrospective study, some
degree of bias is inevitable, but additional information regarding the selection criteria for each
group would be necessary.
2. Despite approximately 70% of cases involving midgut volvulus, the study excluded cases that
underwent emergency Ladd procedure. Is it possible that not all cases with midgut volvulus at
the authors' institution underwent emergency Ladd procedure? It would be helpful to provide
clarification on the differences between included and excluded cases in the study.
3. It seems that the reasons for performing surgery other than midgut volvulus were associated
anomalies. It would be beneficial to provide specific details in the Results regarding these
associated anomalies (ex. Duodenum atresia).
4. Although it is mentioned that two cases in the laparoscopic Ladd (LL) group were converted
to open surgery due to intraoperative bleeding and intestinal swelling, it would be helpful to
have additional information about the age of the cases and the presence of midgut volvulus. It
would be valuable to discuss the factors that make laparoscopic surgery difficult or unsuitable
in certain cases and explore the considerations surrounding this aspect.
Minor point
1. It appears that bowel fixation was not performed. It might be worth adding a section on surgical
techniques to mention that bowel fixation was not performed.
assistant