Minimally Invasive Surgery for Malrotation of the Intestine and Midgut Volvulus

Abstract

Malrotation is defined by an abnormal position and fixation of the bowel within the abdominal cavity. This condition can lead to complications, including life threatening midgut volvulus or various digestive symptoms. The diagnosis of malrotation and its degree of severity can be difficult to assess. Surgery is indicated either to confirm the diagnosis, to treat the malrotation and thus prevent an acute complication, or as an emergency when a midgut volvulus has develop. The treatment involves the correction of the volvulus if present, the release of Ladd’s band and the broadening of the base of the mesentery. The jejunum is left on the right side and the entire colon placed in the left side of the abdomen. Both the diagnosis and the correction of malrotation can be accomplished by laparoscopy, following the steps that will be described in this chapter. Nonetheless, not all patients will be candidate for laparoscopy and some will need an open operation. A fairly high conversion rate is expected, especially when a volvulus is present. The major benefits to be expected, besides cosmesis, are shorter time to enteral feeding, shorter hospital stay and less postoperative adhesive bowel obstructions. The literature clearly support the use of laparoscopy for the diagnosis and treatment of malrotation not associated with volvulus, but, because of a high conversion rate and a possible higher rate of recurrences, the exact place of minimally invasive surgery when a midgut volvulus is present remains controversial.