Name of the Procedure:

Correction of malrotation by lysis of duodenal bands and/or reduction of midgut volvulus (Ladd procedure)

Summary

A Ladd procedure is a surgical intervention that corrects intestinal malrotation, a congenital abnormality where the intestines are improperly positioned. This can lead to serious complications like blockage or twisting of the intestines (volvulus). The surgery involves severing abnormal bands and repositioning the intestines to prevent future problems.

Purpose

The procedure addresses intestinal malrotation and its serious complications, such as intestinal obstruction and midgut volvulus. The primary goal is to prevent life-threatening bowel obstruction and reduce the risk of volvulus, ensuring proper intestinal function.

Indications

• Severe abdominal pain
• Vomiting, often bilious (green/yellow color)
• Signs of intestinal blockage (distention, inability to pass stool)
• Diagnostic imaging showing malrotation or volvulus

The procedure is indicated for patients who exhibit symptoms of malrotation, are diagnosed with midgut volvulus, or are at high risk for these conditions.

Preparation

• Patients are required to fast (nothing by mouth) for a specified period before the surgery.
• Preoperative blood tests, imaging (such as X-rays or an upper GI series), and physical exams are performed.
• Adjustment or cessation of certain medications may be advised.
• Intravenous (IV) fluids and antibiotics may be administered before the procedure.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia to ensure they are asleep and pain-free.
2. Incision: A small incision is made in the abdomen.
3. Lysis of Bands: Any abnormal bands (Ladd's bands) obstructing the intestine are severed.
4. Reduction of Volvulus: If the intestines have twisted, the surgeon will untwist them.
5. Repositioning: The intestines are carefully repositioned within the abdomen to reduce the likelihood of future twisting.
6. Appendectomy: Often the appendix is removed as it can be harder to diagnose appendicitis in its atypical position.
7. Closure: The incision is sutured closed.

Specialized surgical tools, such as scalpels and retractors, as well as laparoscopic equipment, may be used.

Duration

The procedure typically takes between 1 to 2 hours.

Setting

The surgery is performed in a hospital operating room.

Personnel

• Pediatric or general surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Damage to nearby organs or tissues
• Adhesions (scar tissue)
• Recurrence of volvulus
• Complications related to anesthesia

Benefits

• Immediate relief from intestinal obstruction symptoms
• Prevention of future volvulus and related complications
• Improvement in overall bowel function
• Benefits can be realized immediately but full recovery takes time.

Recovery

• Patients are monitored in the hospital for several days post-surgery.
• Pain management is provided through medications.
• Gradual reintroduction of oral intake starting with clear fluids.
• Full recovery typically takes a few weeks; follow-up appointments are necessary to monitor progress.
• Avoid strenuous activities until cleared by the surgeon.

Alternatives

• Non-surgical management in certain non-emergency cases (closely monitored)
• Nutritional adjustments or medications (short-term relief)
• Pros and cons: Non-surgical management may not address the root problem and carries a risk of volvulus recurrence. Surgery offers a more permanent solution but comes with surgical risks.

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not feel pain.
• Postoperative pain and discomfort are managed with medication.
• The patient may experience some abdominal tenderness and limited mobility initially.
• Pain and discomfort typically reduce significantly within a few days post-surgery.