Abstract：
OBJECTIVE: Surgery for intestinal malrotation (IM) aims to correct the defect and improve symptoms; however, many have persistent gastrointestinal (GI) symptoms postoperatively. We evaluated the incidence, clinical presentation, and long-term outcomes of children with surgically repaired IM and its possible association with disorders of gut and brain interaction (DGBI).
METHODS: Multicenter retrospective study was conducted in patients from 0 to 21 years old, who had surgery for IM from 2000 to 2021 across three pediatric tertiary care centers. Data analyzed included demographics, time to diagnosis, idiopathic diagnosis, incidental diagnosis, postoperative follow-up, surgical time, and the need for surgery including bowel detorsion. Outcome variables were the presence of postoperative GI symptoms and DGBIs, and overall resolution of symptoms. We also evaluated the potential association of demographics and other included variables with our outcome variables.
RESULTS: Ninety-two patients with surgically corrected IM were included, 54% were male, and median age of diagnosis and surgical correction was 4.9 and 7.8 months, respectively. Median follow-up after surgery was 64 months. A total of 77% had postoperative GI symptoms, and notably, 78% of patients without symptoms before surgery (incidental diagnosis) developed GI symptoms postoperatively and 27% of patients met Rome IV criteria for a one or more DGBI. No factors were associated to the presence of postoperative symptoms or DGBIs in multivariate analysis. Female gender was the only factor associated with lack of resolution of symptoms at follow-up.
CONCLUSIONS: Pediatric IM is commonly associated with postoperative GI symptoms and DGBI well beyond surgery. An increased awareness about the prevalence of DGBI in these patients may help reach a prompt and accurate diagnosis, and improve their quality of life.
METHODS: Multicenter retrospective study was conducted in patients from 0 to 21 years old, who had surgery for IM from 2000 to 2021 across three pediatric tertiary care centers. Data analyzed included demographics, time to diagnosis, idiopathic diagnosis, incidental diagnosis, postoperative follow-up, surgical time, and the need for surgery including bowel detorsion. Outcome variables were the presence of postoperative GI symptoms and DGBIs, and overall resolution of symptoms. We also evaluated the potential association of demographics and other included variables with our outcome variables.
RESULTS: Ninety-two patients with surgically corrected IM were included, 54% were male, and median age of diagnosis and surgical correction was 4.9 and 7.8 months, respectively. Median follow-up after surgery was 64 months. A total of 77% had postoperative GI symptoms, and notably, 78% of patients without symptoms before surgery (incidental diagnosis) developed GI symptoms postoperatively and 27% of patients met Rome IV criteria for a one or more DGBI. No factors were associated to the presence of postoperative symptoms or DGBIs in multivariate analysis. Female gender was the only factor associated with lack of resolution of symptoms at follow-up.
CONCLUSIONS: Pediatric IM is commonly associated with postoperative GI symptoms and DGBI well beyond surgery. An increased awareness about the prevalence of DGBI in these patients may help reach a prompt and accurate diagnosis, and improve their quality of life.
摘要：
目的：肠旋转不良（IM）的手术旨在纠正缺陷并改善症状；但是，许多患者术后有持续性胃肠道（GI）症状。我们评估了发病率，临床表现,手术修复IM患儿的长期结局及其可能与肠道和大脑相互作用障碍（DGBI）的关系。
方法：在0至21岁的患者中进行了多中心回顾性研究，从2000年到2021年，他在三个儿科三级护理中心接受了IM手术。分析的数据包括人口统计，诊断时间到了,特发性诊断,偶然诊断,术后随访,手术时间,以及需要手术包括排肠术.结果变量是术后胃肠道症状和DGBIs的存在，和症状的整体解决。我们还评估了人口统计学和其他纳入变量与我们的结果变量的潜在关联。
结果：纳入了92例经手术矫正的IM患者，54%是男性，诊断和手术矫正的中位年龄为4.9和7.8个月，分别。术后中位随访时间为64个月。总共77%的人有术后胃肠道症状，尤其是,手术前（偶然诊断）无症状的患者中有78％在术后出现胃肠道症状，而27％的患者符合一种或多种DGBI的罗马IV标准。在多变量分析中，没有因素与术后症状或DGBIs的存在相关。女性性别是与随访时症状缺乏解决相关的唯一因素。
结论：儿科IM通常与术后胃肠道症状和DGBI相关，远超过手术。提高对这些患者中DGBI患病率的认识可能有助于及时准确的诊断。提高他们的生活质量。
方法：在0至21岁的患者中进行了多中心回顾性研究，从2000年到2021年，他在三个儿科三级护理中心接受了IM手术。分析的数据包括人口统计，诊断时间到了,特发性诊断,偶然诊断,术后随访,手术时间,以及需要手术包括排肠术.结果变量是术后胃肠道症状和DGBIs的存在，和症状的整体解决。我们还评估了人口统计学和其他纳入变量与我们的结果变量的潜在关联。
结果：纳入了92例经手术矫正的IM患者，54%是男性，诊断和手术矫正的中位年龄为4.9和7.8个月，分别。术后中位随访时间为64个月。总共77%的人有术后胃肠道症状，尤其是,手术前（偶然诊断）无症状的患者中有78％在术后出现胃肠道症状，而27％的患者符合一种或多种DGBI的罗马IV标准。在多变量分析中，没有因素与术后症状或DGBIs的存在相关。女性性别是与随访时症状缺乏解决相关的唯一因素。
结论：儿科IM通常与术后胃肠道症状和DGBI相关，远超过手术。提高对这些患者中DGBI患病率的认识可能有助于及时准确的诊断。提高他们的生活质量。
