Neonatal Laparoscopic Ladd's Procedure Can Safely Be Performed Even If the Bowel Shows Signs of Ischemia

Abstract

In this we describe two cases of neonatal malrotation with volvulus treated laparoscopically in our institution.CASE 1: A term baby girl was presented on day 3 of life with malrotation and volvulus. On inspection laparoscopically,the cecum was lying in a subhepatic position to the left of the midline. The small bowel was lying on the right, and there was a 180-degree rotation of the bowel. The rotated bowel was viable and of good color.The bowel was derotated, Ladd's bands divided, and the mesentery broadened. She was up to full feeds by postoperative day 2 and was discharged home on the 3rd day postsurgery.CASE 2: A baby boy presented with malrotation and volvulus on day 11 of life. At laparoscopy, there was freechyle in the peritoneal cavity and a midgut volvulus with an ischemic appearing bowel (with the exception of stomach duodenum and descending colon). The bowel was derotated, the ischemic bowel was returned to a healthy color, and Ladd's bands were divided and the root of the mesentery broadened. On post-operative day 2, he was commenced on feeds (expressed breast milk), and by post-operative 4, the baby was tolerating fullfeeds. In our unit, we have performed two laparoscopic Ladd's procedures. Neither of these children have had any complications and, on follow-up, are clinically well with excellent cosmetic results. We feel that laparoscopic treatment of malrotation with volvulus is a feasible procedure and should be performed where the expertise and equipment are available.