The Ladd procedure for malrotation with midgut volvulus consists of four specific steps. Which of the following is NOT part of the Ladd procedure?

• A Counterclockwise detorsion of the volvulus
• B Primary duodenal anastomosis to correct the obstruction ✓
• C Division of Ladd's bands (peritoneal bands from cecum to right abdominal wall crossing the duodenum)
• D Appendectomy

Explanation

The four steps of the Ladd procedure are: (1) counterclockwise detorsion of the volvulus; (2) division of Ladd's bands to relieve duodenal obstruction; (3) broadening of the mesenteric root by separating the cecum from the duodenum to prevent recurrent volvulus; (4) appendectomy (to prevent future diagnostic confusion as the cecum is left in the left abdomen in unphysiological position). Primary duodenal anastomosis is NOT performed — the Ladd procedure addresses anatomical positioning, not a bowel discontinuity.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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