Orbit technique in malrotation with non-obstructive volvulus: A novel technique of devolvulation.

INTRODUCTION: Volvulus may be noted in up to two-thirds of cases involving malrotation beyond infancy. Laparoscopic devolvulation has been described as a frustrating procedure because of restricted visualization. Here, a setup and technique that address these concerns are proposed.

MATERIALS AND SURGICAL TECHNIQUE: Three boys (median age: 7 years) who had been diagnosed preoperatively with malrotation underwent laparoscopic exploration and devolvulation for volvulus found intraoperatively. The children were placed in a dorsal supine modified lithotomy position. Four 5-mm ports were inserted-one umbilically, one in the suprapubic region, and one in both the right and left iliac. After the volvulus was inspected, the right iliac atraumatic grasper was placed at the root of the mesentery. The bowel was devolvulated counterclockwise with the grasper used as a pivot-that is, the orbit technique. Once derotated, the rest of the operation proceeded with the division of Ladd's bands, the widening of the mesentery, and appendectomy.

DISCUSSION: Devolvulation was successful in all three boys. The orbit technique is a useful devolvulation technique in non-obstructive volvulus when other techniques fail.