Clinical case asr laparoscopic ladd's procedure for malrotation correction
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This document discusses laparoscopic correction of intestinal malrotation. It presents two case studies of patients who underwent this procedure, a 5 day old male infant with bilious vomiting and a 6 year old male with episodes of vomiting. The key surgical principles for correcting malrotation laparoscopically are described as evisceration, derotation of the intestines, division of Ladd's bands, widening of the mesenteric base, and ensuring luminal patency. The conclusion is that this procedure is feasible for both neonates and infants, allows for early feeding and shorter hospital stays, and has low risks of reoperation or long-term complications when the mesenteric anatomy is properly assessed and corrected.
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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