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Laparoscopic Ladd’s procedure for intestinal malrotation in an 18-month-old boy

Epublication WebSurg.com, Oct 2017;17(10). URL: http://websurg.com/doi/vd01en5047

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Performing Ladd’s procedure for intestinal malrotation using a laparoscopic approach can be confusing and challenging. This can be attributed to the small working space in children as compared to the length of small and large bowel to be handled. The procedure also requires some understanding of the overall anatomical disorder in order to separate it into smaller steps of correction. The first step is to confirm the diagnosis. The operator has to identify the ligament of Treitz and the presence of Ladd’s bands stretching between the colon and the right abdomen. The bands are divided first to the left of the duodenum, and then between the duodenum and the colon. As a result, the mesentery is widened. Bowel derotation is then started placing the small bowel in the right side and the colon in the left side of the abdomen. The procedure is concluded with an appendectomy.