Ladd Procedure

What is a Ladd procedure?

A Ladd procedure is a surgical treatment for malrotation. Malrotation is a congenital (present at birth) disorder that happens during fetal development. In malrotation, a fetus’s intestines aren’t in the right place within the abdomen. Babies born with malrotation may have severe belly pain or vomit bile.

Malrotation can cause complications like volvulus that causes bowel obstruction and may block the flow of blood and oxygen to your bowel. Volvulus is when a fetus’s intestine twists. This twisting can block a fetus’s bowel. It can keep blood from flowing to a fetus’s intestinal tissue, so the tissue dies (necrosis).

In a Ladd procedure, surgeons untwist the intestines and cut through Ladd’s bands. These are bands of tissue that may form and block the first part of the fetus’s small intestine. Depending on your baby’s symptoms, malrotation may be a medical emergency and your baby may need surgery right away.

When your baby is hurting, you want to do everything that you can to help them. If your baby has malrotation, a Ladd procedure is the only cure. It’s understandable if you’re anxious about your baby having major surgery. It may help to know that your baby’s healthcare team knows this isn’t easy. They’ll do everything they can to help you and your baby through surgery and recovery.

How should I prepare my child for this procedure?

Most babies are less than a year old when their healthcare providers diagnose malrotation and recommend surgery. They’re too little to understand what’s happening to them and why.

If your baby needs to have a Ladd procedure, they’ll need a lot of extra love, care and attention before and after surgery. Being able to help your baby may make you feel less stressed and anxious about the process. Here are some suggestions:

• Plan on an extended hospital stay. Your baby may need to stay in the hospital for several days up to two weeks after surgery. Plan to be with your baby as much as possible during this time. Just knowing you’re near, hearing your voice and feeling your comforting touch will make a difference. Ask family members or friends the baby knows to stay with your baby when you need to take a break.
• Focus on comfort. Remember to bring your baby’s favorite toy or blanket for them to hold before surgery and as they recover.
• Ask about pre-surgery restrictions. You may not be able to nurse or feed your baby for several hours before surgery. But every situation is different, so be sure to check with their surgeon. Nursing or feeding your baby may be comforting for you both.

What happens during a Ladd procedure?

Surgeons typically use laparoscopic surgery to do a Ladd procedure. Rarely, they’ll do open surgery (laparotomy). In laparoscopic surgery, surgeons make three or four tiny cuts (incisions) in your baby’s belly. They use tiny tools to move and smooth out twisted intestines and cut Ladd’s bands. Your baby’s surgeon will recommend the approach they believe is best for your baby.

There are several steps before your baby has surgery:

• Your baby’s healthcare provider will place a nasogastric tube in your baby’s nose that goes to their stomach. The NG tube will empty your baby’s stomach.
• They’ll also place an intravenous (IV) line in one of your baby’s veins. The IV line is how providers will give your baby fluids and medication to prevent infections.
• Your baby will receive general anesthesia so they’re asleep during surgery and won’t feel any pain.

During laparoscopic surgery, your baby’s surgeon will:

1. Make three to four microincisions. These incisions are 3 to 5 millimeters long, or less than an inch
2. Use tiny, laparoscopic tools to untwist your baby’s intestine
3. Check for signs that malrotation affected the blood supply to your baby’s intestine
4. If your baby’s intestine is healthy, their surgeon will place it on the left side of your baby’s belly
5. They’ll remove your baby’s appendix because, in malrotation, babies’ appendices are on the left side of their bellies where your baby’s surgeon will place the newly repositioned intestine; having an appendix isn’t necessary for your baby’s health, so removing it won’t create new medical issues
6. They’ll close the incisions
7. Your baby will be moved into a recovery room where healthcare providers can check on vital signs as your baby recovers from anesthesia

Sometimes, surgeons find the intestinal twisting that happens with malrotation blocks the blood supply to babies’ intestines. If that happens in your baby’s case, they’ll need additional surgery to confirm their intestine is healthy. That surgery will happen within 24 to 48 hours after the first surgery.

How long does a Ladd procedure take?

The surgery typically takes about an hour. The exact time depends on whether your baby’s surgeon will do laparoscopic or open surgery.

What happens after a Ladd procedure?

Healthcare providers will take your baby to a recovery room. There, they’ll keep a close eye on your baby’s vital signs while your baby recovers from the effects of anesthesia. You may want to ask if you can be with your baby while they’re in the recovery room.

Your baby will continue to receive fluids, nutrition and pain medication via an IV until their small intestine heals from surgery and is working as it should. Their surgeon will check to see if your baby is passing gas and pooping. These are signs your baby’s small intestine is healed.

Once your baby’s small intestine works, they’ll be able to nurse, bottle feed or eat solid food. Most babies can start nursing or feeding within two to three days after surgery. If your baby is eating solid food, their surgeon will explain when they can start eating again.

What are the benefits of a Ladd procedure?

The main benefit is that the procedure eliminates malrotation symptoms like belly pain, nausea and vomiting. It reduces the risk your baby will have volvulus. Your baby will be able to nurse or bottle feed and eat solid food as they grow.

How successful is a Ladd procedure?

Most researchers focus on comparing the success rates of open and laparoscopic Ladd procedures. Data varies depending on the study. One analysis of both procedure types shows Ladd procedures successfully treated malrotation in more than 90% of babies who had the surgery.

What are the risks or complications of a Ladd procedure?

Ladd procedure complications may include:

• Infection of the surgery site
• Paralytic ileus
• Short bowel syndrome
• Volvulus (twisted intestine) that comes back

What’s the recovery time after Ladd procedure?

Recovery time is different for every baby and depends on factors like their symptoms, whether they need follow-up surgery and how quickly their small intestine heals.

Your baby will have a follow-up visit with their surgeon about two to three weeks after surgery so their surgeon can check on the incision and your baby’s weight.

What’s the outlook?

Most children who have Ladd procedure for malrotation go on to have typical growth and development. In some cases, however, malrotation symptoms can come back and children will need more surgery.

When should I call my healthcare provider?

Contact your baby’s surgical care team if your baby develops symptoms of an infection at the surgery site. Infection symptoms include:

• Fever (temperature taken with a rectal thermometer that’s greater than 100.4 to 102.2 degrees Fahrenheit or 38 to 39 degrees Celsius)
• Thick, cloudy, white- or cream-colored discharge from the wound
• An opening in the incision line, which may make it deeper, longer or wider
• Redness or color changes in your baby’s skin that go beyond the edge of the incision

You should also contact your baby’s care team if your baby has belly cramps or vomiting. These could be symptoms of recurrent malrotation.

Why is this surgery known as a Ladd procedure?

The procedure is named after pediatric surgeon William E. Ladd, who created the surgical treatment for malrotation. This is one of several surgical procedures Ladd developed to treat digestive issues in babies and children.

Is Ladd procedure treatment for malrotation in adults?

You can have a mild form of malrotation that doesn’t cause symptoms until adulthood. If that’s your situation, a healthcare provider may recommend a Ladd procedure.