Laparoscopic Ladd's procedure for the repair of a right paraduodenal hernia in pediatric patients – A case series

Abstract

Right paraduodenal hernias are a consequence of midgut malrotation resulting in small bowel encased in a peritoneal-lined hernia sac posterior to the right mesocolon. An indistinct presentation often lends a difficult clinical diagnosis and identification on diagnostic laparoscopy; however, when identified, surgical repair should ensue due to a significant lifetime risk of small bowel incarceration. Two female adolescents (ages 12 and 16-years-old) were referred to Pediatric Surgery clinic for intermittent abdominal pain and frequent emesis with radiographic and endoscopic findings consistent with intestinal malrotation. Patients underwent diagnostic laparoscopy at which time a right paraduodenal hernia was identified. Repair was performed via a laparoscopic hernia reduction and laparoscopic Ladd's procedure with appendectomy. Procedure time was 96–206 minutes. There were no intraoperative or postoperative complications to date. Both patients reported near to complete resolution of abdominal pain and emesis. Laparoscopic paraduodenal hernia reduction and Ladd's procedure with appendectomy is a novel, minimally invasive approach to the repair of right paraduodenal hernia in children.