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