Related Experiment Video
Updated: Aug 16, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Laparoscopic treatment of intestinal malrotation in adults
Neal E Seymour1, Dana K Andersen
1Department of Surgery, Baystate Medical Center, Springfield, Massachusetts 01199, USA. neal.Seymour@bhs.org
Insights
Laparoscopic Ladd's procedure effectively treats adult intestinal malrotation symptoms. This minimally invasive approach offers significant relief for abdominal discomfort and related issues, establishing it as a viable alternative to open surgery.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Pediatric Surgery
Background:
- Congenital midgut malrotation is uncommon in adults but can cause significant symptoms.
- The Ladd's procedure is standard for pediatric intestinal malrotation.
- Laparoscopic treatment for adult malrotation requires further validation.
Purpose of the Study:
- To evaluate the efficacy and safety of laparoscopic Ladd's procedure in adult patients with congenital midgut malrotation.
- To assess symptom resolution and patient outcomes following minimally invasive surgical correction.
Main Methods:
- Retrospective review of 7 adult patients (ages 17-45) diagnosed with malrotation via barium small bowel examination.
- Laparoscopic exploration with division of Ladd's bands, appendectomy, and volvulus reduction in 3 patients.
- Assessment of symptoms including postprandial abdominal pain, bloating, and constipation.
Main Results:
- No early complications; patients discharged within 1-3 days.
- 71% of patients reported substantial improvement in abdominal discomfort.
- One patient experienced persistent constipation, and another reported only slight improvement.
Conclusions:
- Adult intestinal malrotation can cause persistent symptoms requiring surgical intervention.
- Laparoscopic Ladd's procedure is an acceptable and effective alternative to open surgery for adults.
- Minimally invasive correction leads to significant symptom relief in most adult patients.
Background:
Congenital midgut malrotation is rarely encountered outside the pediatric population. The Ladd's procedure is the standard corrective measure for intestinal malrotation in children and consists of division of peritoneal bands (Ladd's bands) traversing the posterior abdomen, reduction of volvulus, appendectomy, and functional postioning of the intestine with or without fixation. Clinical manifestations of malrotation and results of Ladd's procedure have been described in adults, but laparoscopic treatment remains to be established as adequate treatment.
Methods:
Records were reviewed of 7 patients, ages 17 to 45, all with a history of abdominal discomfort dating from childhood or early adolescence. The diagnosis of malrotation was made by barium small bowel examination in all cases. Symptoms consisted of recurrent bouts of abdominal pain that were most often postprandial, with bloating and, less frequently, constipation. Surgical treatment consisted of laparoscopic exploration via 4 ports. Peritoneal bands were completely divided, and an appendectomy performed in all patients. Three patients required reduction of nonstrangulated chronic midgut volvulus.
Results:
No early complications occurred, and all patients were discharged on postoperative days 1 through 3. At 2 months to 48 months after surgery, 1 patient had been lost to follow-up. Five patients (71%) reported substantial improvement in abdominal discomfort, with only occasional mild symptoms. Constipation continued in 1 patient, but required less aggressive treatment. One patient reported only slight improvement in postprandial abdominal pain.
Conclusions:
Although rarely encountered, intestinal malrotation after childhood can produce significant clinical symptoms that respond to surgical treatment. The results of the present series indicate that laparoscopic Ladd's procedure is an acceptable alternative to the open technique in treating symptoms of intestinal malrotation in adults.
Related Concept Videos
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...