Laparoscopic repair of gastric volvulus

Abstract

Background and objectives: Acute and chronic gastric volvulus usually present with different symptoms and affect patients primarily after the fourth decade of life. Volvulus can be diagnosed by an upper gastrointestinal contrast study or by esophagogastroduodenoscopy. There are three types of gastric volvulus: 1) organoaxial (most common type); 2) mesenteroaxial; and 3) a combination of the two. If undetected or if a delay in diagnosis and treatment occurs, serious complications can develop.

Methods: We present four cases of surgical repair of organoaxial volvulus consisting of laparoscopic reduction of the volvulus with excision of the hernia sac and reapproximation of the diaphragmatic crura. A Nissen fundoplication, to prevent reflux, was performed, and the stomach was pexed to the anterior abdominal wall by laparoscopic placement of a gastrostomy tube, thus preventing recurrent volvulus.

Results: There were no operative complications, and all four patients tolerated the procedure well. The patients were discharged one to three days postoperatively and were asymptomatic within two months.

Conclusion: With the advancement of laparoscopic Nissen fundoplication and laparoscopic repair of paraesophageal and hiatal hernias, minimally invasive surgical repair is possible. Based on our experience, we advocate the laparoscopic technique to repair gastric volvulus.

Figure 1.

Organoaxial volvulus as shown by upper GI contrast study following reduction by endoscopy. Note position of the nasogastric tube as it courses through the esophagus and makes a 180° turn back into the thoracic cavity.

Figure 2.

The stomach as shown with upper GI contrast study after laparoscopic reduction, Nissen fundoplication and gastrostomy tube placement. The balloon of the G-tube can be visualized within the gastric lumen, and the fundal wrap can be seen in its superior position.

Figure 3.

Chest radiograph showing air-filled viscus in an intrathoracic position behind the cardiac silhouette (black arrows).

Figure 4.

Lateral chest radiograph showing the same air-filled radiograph showing the same air-filled viscus in an intrathoracic position behind the heart (white arrows).

Figure 5.

The stomach as it appears after upper GI contrast study showing an organoaxial volvulus (“upside-down stomach”). Note position of the nasogastric tube as it courses through the gastroesophageal junction below the diaphragm and turns 180° back into the thoracic cavity.