CPT® Code 44055

Correction of malrotation by lysis of duodenal bands and/or reduction of midgut volvulus, commonly referred to as the Ladd procedure, addresses a congenital anomaly known as intestinal malrotation. This condition arises when the intestines fail to properly rotate to the left of the superior mesenteric artery (SMA) during fetal development, specifically between the 4th and 12th weeks. The surgical intervention involves a midline abdominal incision to access the intestines. In cases where a midgut volvulus is present, the entire small bowel and transverse colon are carefully extracted from the abdominal cavity. The typical presentation of malrotation leads to a clockwise twisting of the intestines, necessitating the surgeon to untwist the bowel in a counterclockwise direction to alleviate the volvulus. Following this, the viability of the bowel is thoroughly inspected to ensure there is no compromise to its blood supply. The procedure also involves repositioning the cecum into the left upper quadrant and exposing the duodenum for a comprehensive examination along its entire length. The surgeon checks for any external obstructions caused by fibrous bands of tissue that may be present between the duodenum and the peritoneum, which are then lysed. Additionally, bands may be located at the ileum or jejunum, and if they are found to be attached to the gallbladder or liver, these are also lysed. To confirm the absence of internal obstructions, a nasogastric tube is passed through the duodenum. Furthermore, an incidental appendectomy is performed prior to closing the abdomen to mitigate the risk of damage to the appendiceal vessels during the lysis of bands.