Objective: To explore the effect of laparoscopic Ladd surgery in children with intestinal malrotation and its effect on serum T cell subsets. Methods: A total of 65 children with intestinal malrotation were randomly divided into a laparoscopy group and a control group. Children in the control group were received conventional open Ladd surgery, while the others in the laparoscopic group were received laparoscopic Ladd surgery. The operative time, intraoperative blood loss volume, postoperative anal exhaust time, and hospitalization time were then compared between the two groups. The levels of T cell subsets and NK cells in peripheral blood of the 2 groups were compared before the surgery, 24 h after the surgery and 5 d after the surgery. The incidence of postoperative complications was compared between the 2 groups. Results: The operation time of children in the laparoscopic group was longer than that in the control group (P<0.05), and the intraoperative blood loss volume, postoperative anal exhaust time, and hospitalization time were all less than those in the control group (all P<0.05). The serum levels of CD3+, CD4+, CD4+/CD8+ and NK cells in the laparoscopic group were all higher than those in the control group (all P<0.05), and the level of CD8+ in the laparoscopic group was lower than that in the control group (P<0.05) 24 h after the surgery. The serum levels of CD4+, CD4+/CD8+ and NK cells in the laparoscopic group were all higher than those in the control group (P<0.05), and the level of CD8+ in the laparoscopic group was lower than that in the control group (P<0.05) 5 d after the surgery. The total incidence of complications in the laparoscopic group (3.1%) was lower than that in the control group (24.2%), (P<0.05). Conclusion: Laparoscopic Ladd surgery has a certain curative effect but little trauma on children with intestinal malrotation, and has less immunosuppressive effect, faster recovery, and lower incidence of complications.