Laparoscopic Approach to Malrotation

Rotational anomalies of the intestine are well described in the pediatric surgical literature. The deep understanding of these anomalies their surgical management differentiate the pediatric surgeons from their adult surgery colleagues. The diagnostic and operative approaches to these problems have developed consistently over the last several decades as techniques and understanding have progressed. The potentially devastating outcomes of malrotation, nonrotation, and volvulus generally necessitate operative repair. The open technique was originally described by William Ladd in the 1930s, hence the eponymous “Ladd’s Procedure.” Since then, although the principles of the operation have remained the same, minimally invasive approaches have also been applied. Herein, we provide a review of the laparoscopic approach to surgical correction of abdominal rotation anomalies. Included in this chapter are a discussion of the preoperative workup, anesthetic considerations, and peri-operative pearls and pitfalls of laparoscopic repair.