A Ladd operation is a surgical treatment. An issue with the positioning of a baby’s intestines in his or her stomach is resolved with this procedure. The Ladd technique, initially established by Ladd in 1936, is the primary treatment for intestinal malrotation. The prognosis of intestinal malrotation is considered favourable if there is no preterm, intestinal necrosis, or midgut volvulus.
The intestines of a baby turn inside the body as they grow before they are born. In most cases, the intestines continue to turn until they reach their proper location inside the belly. However, if they begin to turn but do not complete it, they will not be in the correct position. This is referred to as malrotation.
Malrotation causes the gut to twist and become obstructed. If the intestine is not untwisted immediately, it can damage and will need to be removed from the body. Ladd’s procedure can help in preventing the intestines from folding and functioning properly.
Ladd’s Procedure Steps
The following are the steps of the technique:
- If a volvulus is present, it should be detorted or reduced in a counter-clockwise direction.
- The irregular peritoneal bands (Ladd’s bands) overlaying the duodenum are divided, easing the intermittent obstruction’s source.
- The duodenum is mobilized to expand the constricted root of the small bowel mesentery.
- The adhesions around the SMA (Superior Mesenteric Artery) were divided to prevent future volvulus, and the small bowel was moved to the right side of the abdomen and the caecum to the left, as well as an appendectomy.
- The intestine will be moved into a better position in the stomach by the doctor. Additionally, he or she will remove the baby’s appendix. This aids in the prevention of future issues. Following the surgery, the infant will be constantly monitored. Any changes in health that require additional therapy will be investigated by the care team.
Ladd’s Procedure Complications
Bowel obstruction after adhesion is a known risk factor. The most prevalent and serious postoperative consequence is adhesion-related obstruction.
Adhesion-related blockage occurs most frequently in the first year after surgery, but it can happen at any time. These blockages may respond to non-surgical treatment, but they may also necessitate operational treatment, which carries a high risk of significant morbidity. The likelihood of recurrent midgut volvulus is extremely low due to Ladd’s procedure, it should be addressed in patients who have previously undergone Ladd’s surgery and continue to experience gastrointestinal symptoms.
Ladd’s Procedure Indications
The following are some of the indications of the procedure:
- Stomach Ache.
- Reflux disease of the stomach and esophagus.
- Vomiting that is not bilious.
- Symptomatic malrotation without indication of volvulus.
- The possibility of a volvulus.
Ladd’s Procedure Recovery
Children heal at various rates. The baby’s recovery time will be determined by the symptoms he or she had before surgery. It also relies on the condition of the gut. The baby may have to stay in the hospital for several days.
After the surgery, the baby will be given pain medication. He or she will be attentively observed. The baby’s bowels will be checked by the care team to ensure that they are working properly.
The doctor will give the instructions when it is time to go home. He/she will cover topics such as how to care for the baby’s incision and what medications he or she will require.
The child is brought to a hospital room about an hour after surgery. Critically unwell children are transferred to an intensive care unit (ICU) or a neonatal intensive care unit (NICU) and subsequently to a room when they are ready. Children who have had surgery for malrotation normally stay in the hospital for almost a week, depending on how quickly their intestine heals.
After the procedure babies are fed by an IV line for several days. This is because the intestines need to rest for a while before they can resume their functions. When the child’s intestines begin to function, he or she will pass gas, and doctors will advise that normal eating should be resumed.
When a child is in the hospital, the surgeon will be in continual communication with both the child and their family. A follow-up appointment is planned 2-3 weeks after the child is released from the hospital to ensure that the intestine is functioning well and that the surgical incision is healing.