Does your little one often suffer from stomach aches and vomit greenish-yellow vomit? Perhaps the doctor said that the baby has a congenital problem with his intestines, meaning that the intestines are positioned incorrectly? This is what we medically call `(Malrotation)`. The doctor may have also said that he needs to do a `Ladd' procedure as a treatment for this. So, it is very normal for you to feel a lot of fear and anxiety. So today we will talk about everything clearly, simply, and in a way that you can understand.
What is the Ladd Procedure?
Simply put, when the intestines are not in the correct position inside the abdomen when the baby is in the womb, we call this `(Malrotation)`. This is a congenital condition.
The most dangerous thing about this is that sometimes the intestines that are misaligned in this way can twist together. Think of it like holding a water pipe by both sides and twisting it. We call this volvulus . When this happens, the blood supply to the intestines can be completely cut off, and those parts can even die (necrosis). This is a very emergency situation.
In addition, abnormal bands of tissue called ``Ladd's bands'' can form and block the first part of the intestine (duodenum). This can cause the baby to be unable to digest food and to vomit frequently.
So what this LAD surgery does is that surgeons straighten out these twisted intestines, cut out those obstructing strips of tissue, and place the intestines in the correct, safe place inside the abdomen.
I understand the anxiety you feel when you hear about surgery for your baby. But this is the only and best treatment for `(Malrotation)`. Your medical team will not leave you and your baby alone on this journey, they will explain everything.
How to prepare a baby for surgery?
This surgery is often done on babies under one year old. So they don't understand what's going on. That's why your love and care as a parent is so important to your baby at this time. There are a few things you can do.
- Prepare for the hospital stay: You will need to stay in the hospital for a few days, possibly two weeks, after the surgery. Try to stay close to your baby as much as possible. Your voice, your comforting touch are a great source of comfort to your baby. When you need a break, ask a family member who knows your baby well to stay with you.
- Make your baby comfortable: Bring something your baby loves, such as a toy or a small blanket. Having it with you before and after the surgery will help your baby feel comfortable.
- Ask about food and drink: You may need to stop breastfeeding and feeding your baby a few hours before surgery. This may vary for each baby, so talk to your surgeon about this.
How is the surgery done?
Most of the time, this surgery is done laparoscopically. That is, what we call 'keyhole' surgery, which is done with a camera. In this, only a few small incisions are made in the abdomen. Rarely, depending on the situation, an open surgery called a 'laparotomy' may be performed. The surgeon will decide which method is best for your baby.
| What happens before and during surgery | |
|---|---|
| Preparation before surgery | |
| Nasal tube (NG tube) | A small tube is inserted through the nose into the stomach to empty the contents of the baby's stomach. |
| Putting saline in the arm (IV line) | A saline solution is placed in a vein in the arm. This is where the necessary fluids, painkillers, and medications to prevent infection are given. |
| General Anesthesia | The baby is put to sleep completely, so there is no pain during the surgery. |
| During surgery | |
| Making small incisions | For the laparoscopic method, 3 or 4 small incisions of 3-5 mm are made in the abdomen. |
| Bowel correction | The twisted intestine is carefully stretched and the obstructing ``Ladd's bands'' tissue is cut and removed. |
| Appendix removal | When the intestines are repositioned, the appendix is in the wrong place. Because it could be a problem in the future, it is also removed during this surgery. It does not harm the baby. |
| Bowel repositioning | If the intestine has a good blood supply, it is safely placed on the left side of the abdomen. |
Sometimes, if there is a suspicion that the blood supply has been cut off due to twisting of the intestines and damage to the intestines, another surgery may be necessary within 24-48 hours of the first surgery to confirm the health of the intestines.
What happens after the surgery?
After surgery, the baby is taken to a recovery room, where doctors and nurses monitor the baby's heart rate and breathing. Fluids and nutrition are given through a saline (IV) until the baby's intestines start working again (i.e., passing gas and stool ).
After the intestines start working, the baby can start drinking milk and eating food again in about two to three days.
What are the benefits and risks of this surgery?
The main advantage is that it completely cures the ``Malrotation`` condition. However, as with all surgeries, there are some minor risks.
| Benefits | Risks/Complications |
|---|---|
| Symptoms such as stomach pain and vomiting disappear. | Infection at the surgical site. |
| The dangerous risk of intestinal twisting (volvulus) is eliminated. | Paralytic ileus is a temporary stoppage of intestinal function. |
| The baby will be able to drink milk and eat normally. | Short bowel syndrome (if part of the intestine is removed). |
| The baby is experiencing normal growth and development. | Rarely, repeated twisting of the intestines (Volvulus). |
When should I call the doctor?
After you bring your baby home from surgery, call your surgeon or the hospital immediately if you notice any of the following symptoms. These could be signs of an infection:
- Fever: If the rectal temperature is higher than 100.4°F (38°C).
- Pus oozing from the wound: If a thick, white or cream-colored fluid is coming from the wound.
- Opening the wound: If the wound is open and the stitches have come loose, there is a visible deepening.
- Redness around the wound: The skin around the incision is red and the redness is spreading.
Also, if the baby has stomach pain again and vomits green, it means that the symptoms may be reappearing. If that happens, you should call the doctor immediately without delay.
Take-Home Message
- The Ladd Procedure is the only and most successful treatment for malrotation, a congenital defect of the intestines.
- This can prevent the dangerous condition of ``Volvulus``, where the intestines twist and lose their blood supply.
- If you have any fears or concerns about the surgery, talk to your doctor about it openly. They will explain everything to you.
- If you develop signs of infection (fever, pus from the wound) or symptoms recur (vomiting, stomach pain) after surgery, seek medical advice immediately.
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