FIGURE 2.

The technical steps of the gut malrotation correction (GMC) surgery “Kareem's procedure”. After dissection of the duodenum, the third and fourth part were rotated (curved arrow) to the left side 180° behind the mesenteric hilum (superior mesenteric artery and vein) to complete the embryonic 270° counterclockwise midgut rotation (A-B). With proper vascular orientation, duodenopexy was completed with interrupted silk sutures creating a neo-ligament of Treitz (red arrow) in the left upper abdominal compartment (B-C). After complete dissection and freeing of the colon, the cecum and right colon were placed in the right side of the abdominal cavity and fixed into the posterior and lateral peritoneum, respectively (D). Note the resultant subsequent reversal of the vascular inversion (red arrow) . After colonic resection, when indicated, the mesenteric root is fixed to the posterior peritoneum along the diagonal long axis (double arrow line) between the cecum and neo-ligament of Treitz with interrupted silk sutures (E).