LAPAROSCOPIC LADD PROCEDURE AND ASSESSMENT OF MALROTATION

Upper gastrointestinal series are frequently obtained on children with abdominal pain and vomiting, If the ligament of Treitz (LOT) is in an equivocal position and not to the left of the spine at L1 or L2 it is important to determine the position and fixation of the cecum to asse ss the breadth of the mesenteric pedicle, Radiographic studies may not accurately accomplish this because of the changing position of the ce cum, Laparoscopy can be used to determine the position of LOT and whet her the cecum is fixed in the right lower quadrant, If the patient is judged to be at risk for volvulus (i,e,, a shortened mesenteric pedicl e) a Ladd's procedure can be accomplished laparoscopically with good l ong-term results, The use of the laparoscope is not advocated when acu te volvulus is suspected.