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Clinical case asr laparoscopic ladd's procedure for malrotation correction
 

Clinical case asr laparoscopic ladd's procedure for malrotation correction

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    Clinical case asr laparoscopic ladd's procedure for malrotation correction Clinical case asr laparoscopic ladd's procedure for malrotation correction Presentation Transcript

    • If you will not be better tomorrow thanyou were today,then what do you need tomorrow for ?
    • LAPAROSCOPICCORRECTION OFMALROTATION- byDR AMIT SITAPARANeonatal & Pediatric Laparoscopist
    • BACKGROUND
    • PRESENTATION• Acute Duodenal obstruction after birth• Asymptomatic / Minimally symptomatic• Acute midgut volvulus• Chronic midgut volvulus• Chronic Duodenal Obstruction due tobands• Internal hernia• Cecal volvulus• Reverse rotation with colonic obstruction
    • SURGICAL PRINCIPALS• Evisceration• De rotation• Division of Ladd’sbands• Widening of mesentericbase• Check luminal patency• Appendectomy
    • Before After
    • CASE - 1• 5 days old, male• Bilious vomiting• Scaphoid abdomen• Passing stools• X ray abdomen
    • CASE - 2• 6 yrs old, male• Episodes of vomitingevery few months• Abdominal pain• No abdominaldistention or bowelcomplaints• Barium meal
    • REFRRENCES• Ure BM, Bax NM, Zee DC. Laparoscopy in infants and children: a prospective study on feasibilityand 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. SurgEndosc.1995;9:1123–1124. [PubMed]• Fraser JD, Aguayo P, Sharp SW, Ostlie DJ, St Peter SD. The role of laparoscopy in themanagement 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 inthe 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 ininfants. 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 andappendectomy 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. SurgEndosc. 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. SurgEndosc.1999;13:1160–1162. doi: 10.1007/s004649901196. [PubMed] [Cross Ref]• Bass KD, Rothenberg SS, Chang JH. Laparoscopic Ladd’s procedure in infants withmalrotation. 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 approachto malrotation without midgut volvulus. Am Surg. 2007;73:693–696. [PubMed]
    • 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 causefor re do surgery• Adhesive obstruction & CAP are two mainlong term benefits
    • To see the edited video of this visit…www.bestpediatricsurgeon.com orwatch on You tube, Dr Amit Sitapara
    • THANK YOU