OR / Prep · Pediatric Surgery · open
You’re scrubbing into
Ladd's procedure for malrotation
Why are we operating?
The bilious-vomiting emergency: untwist the volvulus the wrong-rotated gut allowed, divide the bands, and widen the mesenteric stalk so it cannot twist again.
Indication: Malrotation with midgut volvulus is the emergency; malrotation found otherwise is discussed case by case.
The operation in 4 steps
01Entry and assessment
02Detorsion
03Dividing Ladd's bands and widening the mesentery
04Appendicectomy and final placement
Danger zones
Iliohypogastric nerve
Runs between the oblique layers; injury causes groin numbness and weakens the inguinal canal mechanism.
Cecum
Immediately deep to the peritoneum; the reason the peritoneum is tented before opening.
Appendiceal artery
An end artery in the mesoappendix, secure ligation is the operation's key vascular step.
Watch it done
Laparoscopic Ladd's procedure
Dividing the bands, widening the mesentery, the appendix, and the bowel laid in non-rotation.
Source: SAGES · Watch on YouTube
Conceptual teaching for learners preparing to observe and assist under supervision, not operative instructions. Five minutes from now you should know why this operation exists, what its shape is, and which structures it is designed not to injure.