Laparoscopic Ladd's Procedure

Laparoscopic Ladd's Procedure

Alejandra M. Franco, MD; Erick Silva, MD

TEC de Monterrey

Objective: To present a case report of a laparoscopic Ladd’s procedure

Methods and Procedures Used: 11 year old girl who complained of bilious emesis and abdominal pain. Past medical and surgical history was unremarkable. Her mother referred spontaneous resolution of the episodes. Upper GI series confirmed midgut malrotation diagnosis. Ladd's procedure was scheduled. Laparoscopic approach through three 5mm ports was performed. Duodenal volvulus, ileum and jejunum were identified in the patient's right side. Colon was fixed to the left side. Volvulus was relieved and Ladd bands were divided completely. The mesentery was partially extended. The duodenum was fixed to the right abdominal wall and incidental appendectomy was performed. Final inspection confirmed the mesentery was flat without torsion.

Results and Conclusions: Surgical results depend on the bowel’s condition at the time of the initial procedure. Recurrent volvulus and duodenal obstruction are rare. Most common complication is small bowel obstruction secondary to adhesions. Laparoscopic approach is safe, associated with earlier enteral feeding.