Clinical case asr laparoscopic ladd's procedure for malrotation correction

1. If you will not be better tomorrow than
you were today,
then what do you need tomorrow for ?

3. LAPAROSCOPIC
CORRECTION OF
MALROTATION
- by
DR AMIT SITAPARA
Neonatal & Pediatric Laparoscopist

4. BACKGROUND

6. PRESENTATION
•Acute Duodenal obstruction after birth
•Asymptomatic / Minimally symptomatic
•Acute midgut volvulus
•Chronic midgut volvulus
•Chronic Duodenal Obstruction due to
bands
•Internal hernia
•Cecal volvulus
•Reverse rotation with colonic obstruction

7. SURGICAL PRINCIPALS
•Evisceration
•De rotation
•Division of Ladd’s
bands
•Widening of mesenteric
base
•Check luminal patency
•Appendectomy

9. Before After

10. CASE - 1
•5 days old, male
•Bilious vomiting
•Scaphoid abdomen
•Passing stools
•X ray abdomen

12. CASE - 2
•6 yrs old, male
•Episodes of vomiting
every few months
•Abdominal pain
•No abdominal
distention or bowel
complaints
•Barium meal

15. REFRRENCES
•Ure BM, Bax NM, Zee DC. Laparoscopy in infants and children: a prospective study on feasibility
and the impact on routine surgery. J Pediatr Surg. 2000;35:1170–1173. doi:
10.1053/jpsu.2000.8720.[PubMed] [Cross Ref]
•Zee DC, Bax NM. Laparoscopic repair of acute volvulus in a neonate with malrotation. Surg
Endosc.1995;9:1123–1124. [PubMed]
•Fraser JD, Aguayo P, Sharp SW, Ostlie DJ, St Peter SD. The role of laparoscopy in the
management of malrotation. J Surg Res. 2009;156:80–82. doi: 10.1016/j.jss.2009.03.063. [
PubMed] [Cross Ref]
•Frantzides CT, Cziperle DJ, Soergel K, Stewart E. Laparoscopic Ladd procedure and cecopexy in
the treatment of malrotation beyond the neonatal period. Surg Laparosc Endosc. 1996;6:73–75.
doi: 10.1097/00019509-199602000-00018. [PubMed] [Cross Ref]
•Gross E, Chen MK, Lobe TE. Laparoscopic evaluation and treatment of intestinal malrotation in
infants. Surg Endosc. 1996;10:936–937. doi: 10.1007/BF00188488. [PubMed] [Cross Ref]
•Lessin MS, Luks FI. Laparoscopic appendectomy and duodenocolonic dissociation (LADD)
procedure for malrotation. Pediatr Surg Int. 1998;13:184–185. doi: 10.1007/s003830050284. [
PubMed] [Cross Ref]
•Tsumura H, Ichikawa T, Kagawa T, Nishihara M. Successful laparoscopic Ladd’s procedure and
appendectomy for intestinal malrotation with appendicitis. Surg Endosc. 2003;17:657–658. doi:
10.1007/s00464-002-4516-7. [PubMed] [Cross Ref]
•Brennan TV, Horn JK, Stollman NH. Laparoscopic treatment of acute mesenteric torsion. Surg
Endosc. 2002;16:1004. [PubMed]
•Yamashita H, Kato H, Uyama S, Kanata T, Nishizawa F, Kotegawa H, Watanabe T, Kuhara T.
Laparoscopic repair of intestinal malrotation complicated by midgut volvulus. Surg
Endosc.1999;13:1160–1162. doi: 10.1007/s004649901196. [PubMed] [Cross Ref]
•Bass KD, Rothenberg SS, Chang JH. Laparoscopic Ladd’s procedure in infants with
malrotation. J Pediatr Surg. 1998;33:279–281. doi: 10.1016/S0022-3468(98)90447-
X. [PubMed] [Cross Ref]
•Draus JM, Jr, Foley DS, Bond SJ. Laparoscopic Ladd procedure: a minimally invasive approach
to malrotation without midgut volvulus. Am Surg. 2007;73:693–696. [PubMed]

16. CONCLUSION
•Feasible in both neonates and infants
•Early resumption to feeds & shortens stay
•Success depends on ability to assess,
identify & correct the mesenteric anatomy
•Low threshold to conversion
•Inadequate correction is the main cause
for re do surgery
•Adhesive obstruction & CAP are two main
long term benefits

17. To see the edited video of this visit…
www.bestpediatricsurgeon.com or
watch on You tube, Dr Amit Sitapara

18. THANK YOU