Video-Laparoscopic Treatment of Intrathoracic Gastric Volvulus

Abstract

Background: Gastric volvulus is a rare condition, characterized by abnormal rotation of the stomach, causing obstruction with risk of ischemia, necrosis, and perforation. It is associated with high morbidity and mortality rates and, as it is life threatening, early diagnosis and treatment are crucial.Methods: Retrospective study of medical records of intrathoracic gastric volvulus patients treated by video-laparoscopy from January 2000 to December 2018, in a University Hospital.Results: Thirty patients (34 surgical procedures -4 reoperations), 9 (30%) male and 21 (70%) female. The mean age was 57.65 6 32.65 and the mean body mass index was 27.11 6 3.5 kg/m 2 . The most prevalent symptoms were epigastric pain and dysphagia. In 41.17% of the cases, the contrast X-ray confirmed the diagnosis. All 34 cases were intrathoracic volvulus, 24 of which were organo-axial (70.58%). The surgical technique used was hiatoplasty, without mesh (25 cases; 73.52%) and with reinforcement mesh (9 cases; 26.47%), mostly associated with Nissen fundoplication (52.94%). The mean surgical time was 215.7 6 62.9 minutes, with conversion in 5 cases (15.62%). Hospitalization ranged from 4 6 2 days. There was no record of operative mortality, and symptom improvement occurred in 100% of patients. The mean follow-up time for patients was 41.8 6 32.6 months.Conclusions: Surgical treatment should be indicated to reduce morbidity and mortality, and associated with improved symptoms and patient prognosis. Video-laparoscopic surgery on intrathoracic gastric volvulus proved to be safe and effective and should be the option of choice in the management of this disease.

Management and Outcomes in Gastric Volvulus: A Tiered Approach

“…Currently, the mainstay surgical intervention involves decompression of the obstructed stomach using either nasogastric tube or endoscopy followed by laparoscopic repair as reported by Channer and colleagues first in the year 2000. 2 More recent methods of single-incision laparoscopic gastropexy 6 and video-assisted laparoscopy 7 have also been reported with good results. However, most of the data presented in the literature tend to suffer from a short length of follow-up and the exact rate of recurrence of the various techniques; whether it is endoscopic reduction, gastropexy, and/or other surgical correction largely remains unknown.…”