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LAPAROSCOPIC CORRECTION OF MALROTATION

- by

DR AMIT SITAPARANeonatal & Pediatric Laparoscopist

BACKGROUND

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

SURGICAL PRINCIPALS

• Evisceration• De rotation• Division of Ladd’s

bands• Widening of mesenteric

base• Check luminal patency• Appendectomy

Before After

CASE - 1

• 5 days old, male• Bilious vomiting • Scaphoid abdomen• Passing stools • X ray abdomen

CASE - 2

• 6 yrs old, male• Episodes of vomiting

every few months• Abdominal pain• No abdominal

distention or bowel complaints

• Barium meal

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]

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

To see the edited video of this visit…

www.bestpediatricsurgeon.com or

watch on You tube, Dr Amit Sitapara

THANK YOU