Laparoscopic Ladd's procedure for intestinal malrotation in adults: a single center experience

Abstract Introduction Laparoscopic Ladd’s procedure (LLP) is an established technique to treat intestinal malrotation, a congenital condition that may lead to volvulus and bowel obstruction. Traditionally, Ladd’s procedure has been performed using open surgery, but the laparoscopic approach in adults has been reported in a few centers. Method The procedure includes division of Ladd’s bands, and other adhesions, which cause intestinal obstruction, and the small intestine is repositioned to the right side of the abdomen while the colon is placed on the left to reduce the risk of volvulus. Appendectomy is often performed to prevent diagnostic confusion in future cases of abdominal pain. Result Between 2014-2025, twenty-five patients with intestinal malrotation underwent LLP at Ersta hospital (9M/16F, median age 50 years, LOS 3 days, follow-up 63 months). Indications were abdominal pain and/or volvolus. One conversion in a patient with extensive previous surgery. Although initial recovery was usually uneventful, readmissions(n=5) and reoperations(n=5) due to high ileus(3-duodenal obstruction), small bowel perforation(1) and bleeding from appendix stump(1) occurred. One more operation during long-term follow-up in four patients, due to adhesions(1), high ileus(1-required GE), small bowel resection(1-Crohn), and volvolus(1). One patient underwent LLP seven more times during follow-up, due to repeated midgut volvolus. No resections due to ischemia has been required. Discussion Laparoscopic Ladd’s procedure, often a challenge due to previous surgery and a complex clinical history, has acceptable clinical outcomes and low conversion rates, when laparoscopic expertise is available. However, patients need follow-up and access to care without much delay due to increased risk of obstruction/volvolus.