From the Research
The surgery to repair volvulus in infants is called a Ladd's procedure, which should be performed via an open approach due to the higher risk of recurrent volvulus associated with the laparoscopic method in neonates, as indicated by the most recent and highest quality study 1.
Overview of the Procedure
The Ladd's procedure is a surgical intervention designed to correct malrotation of the intestine and treat midgut volvulus. During the procedure, the surgeon untwists the volvulus, divides abnormal peritoneal bands (Ladd's bands) that may be causing obstruction, widens the mesentery base to prevent future twisting, and typically performs an appendectomy.
Considerations for Surgical Approach
In emergency situations, the surgeon will also assess intestinal viability and may need to resect any necrotic bowel segments. While the procedure can be performed through traditional open surgery or laparoscopically, the choice of approach depends on the infant's condition and surgeon's expertise. However, given the findings from 1, which suggest a higher risk of recurrent volvulus with the laparoscopic approach in neonates, the open approach is recommended for this age group.
Importance of Prompt Intervention
Prompt surgical intervention is crucial as volvulus represents a surgical emergency that can lead to intestinal ischemia, necrosis, and perforation if not treated quickly. After surgery, the infant will require close monitoring for proper intestinal function and potential complications, as highlighted by long-term follow-up studies such as 2, which noted significant long-term morbidity associated with intestinal malrotation even after corrective surgery.
Key Points for Management
- Surgical Procedure: Ladd's procedure is the standard surgical intervention.
- Surgical Approach: Open approach is recommended for neonates due to the higher risk of recurrent volvulus with laparoscopic surgery.
- Post-Surgical Care: Close monitoring for intestinal function and potential complications is essential.
- Long-Term Considerations: Education about the potential for small bowel obstruction and other long-term complications is crucial for the parents of these children, as indicated by studies such as 2 and 3.