Ladd’s Procedure
Untwisting the bowel and repositioning it so it cannot twist again.
What is Ladd’s Procedure?
An operation that untwists a volvulus, divides the abnormal bands, widens the base the bowel hangs from, and places the small bowel on the right and the colon on the left so a twist cannot recur. The appendix is removed because it ends up in an unusual position.
Hospital stay
A week or more.
Performed by
Dr. Pratheep Samraj
- The problem
Why It Is Done
Surgery is advised in these situations. The decision is always made after examining your child, never from a description.
- Emergency: a baby with bile-stained vomiting and suspected volvulus — this is measured in hours, not days
- Elective: malrotation found without twisting, to prevent a future volvulus
- In an older child with recurrent symptoms and confirmed malrotation
Before the Day
- Immediate resuscitation — nothing by mouth, a nasogastric tube, intravenous fluids and antibiotics
- An upper GI contrast study confirms the diagnosis where the child is stable enough
- In a clearly unwell baby, surgery is not delayed to complete investigations
During the Operation
- General anaesthetic
- The bowel is untwisted and its viability assessed
- Bands are divided, the mesenteric base broadened, the bowel repositioned, appendix removed
- Dead bowel is removed; if viability is uncertain a planned second look in 24 to 48 hours is standard
Afterwards, and at Home
- Intensive care support, with intravenous nutrition until bowel function returns
- A week or more in hospital, considerably longer if bowel had to be removed
- Feeds reintroduced gradually
What Can Go Wrong
- Loss of bowel if the volvulus was long-standing, with lifelong nutritional consequences
- Adhesions causing obstruction later
- Recurrence of volvulus, which is uncommon after a properly performed Ladd procedure
- The risks of major emergency surgery in an unwell baby
Every operation carries risk. These are listed openly because a parent consenting to surgery is entitled to know them — not because they are expected. The surgeon will go through which of them actually apply to your child.
Common Questions
If your question is not here, send it on WhatsApp and the hospital team will answer.
Dr. Pratheep Samraj
Consultant Paediatric & Neonatal Surgeon · Palliyadi, Kanyakumari
Super-specialist surgical care for newborns, infants and children, with expertise in paediatric urology, congenital anomalies, gastro-intestinal surgery and minimally invasive surgery.
For a volvulus this is emergency surgery. Found by chance, it is a planned one.
Either way it stops the bowel twisting again, which is the whole point of doing it. Bring the contrast study if one has already been done.
Consultation 10:00 AM - 1:00 PM & 4:00 PM - 8:00 PM · 24-hour laboratory & pharmacy
In an emergency — green vomiting in a baby, a groin swelling that will not go back, severe tummy pain, or a newborn not passing urine or meconium — come straight to the hospital or to your nearest emergency department. Do not wait for a reply to a message.