The Ladd procedure for malrotation and midgut volvulus involves four essential steps. Which step is unique to this operation and prevents recurrent volvulus?
- A Pyloromyotomy to decompress the stomach
- B Broadening the mesenteric base by dividing Ladd's bands and placing the small bowel on the right and colon on the left ✓
- C Right hemicolectomy to remove the non-rotated cecum
- D Duodenoduodenostomy for duodenal obstruction
Correct answer: B. Broadening the mesenteric base by dividing Ladd's bands and placing the small bowel on the right and colon on the left
Explanation
The Ladd procedure consists of: (1) detorsion of the volvulus counterclockwise; (2) division of Ladd's bands (fibrous peritoneal bands crossing and compressing the duodenum); (3) broadening the base of the mesentery to prevent re-volvulus by placing the small intestine on the right side of the abdomen and the colon on the left (anatomically unrotated position); and (4) appendectomy to prevent confusing future right iliac fossa pain. The mesenteric broadening is the key anti-volvulus step since the narrow mesenteric base predisposes to twisting.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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