Single-incision laparoscopic gastropexy for mesentero-axial gastric volvulus

Abstract

Background: Mesentero-axial gastric volvulus (MAGV) is a rare but critical condition as delay in treatment can lead to lethal situations. Although the report of the surgical treatment with laparoscopic approach for MAGV has recently come to be seen, no standard procedures have been established. We aim to describe our operative technique of single-incision laparoscopic gastropexy (SILG) for MAGV and review the relevant literature to ascertain the most appropriate treatment option in these patients.

Case presentation: Three patients were referred to our hospital because abdominal pain and vomiting suddenly occurred. Acute MAGV was diagnosed by upper gastrointestinal study. After overnight gastric decompression with a nasal tube, the GV was resolved spontaneously. Elective SILG was planned. Single incision at the umbilicus was made and three 5-mm trocars were inserted. The anterior wall of the body of the stomach was sutured to the peritoneum using 6 × 4-0 non-absorbable sutures for prevention of recurrence of GV and occurrence of internal hernia through the space created between the sutures. Two boys and a girl with mean age 4 ± 2 years underwent SILG. The mean time of the operation was 48 ± 23 min. All of the procedures were completed safely, and there were no postoperative complications. The mean time of postoperative hospitalization was 4 ± 1 days. All patients had good cosmetic and clinical results.

Conclusion: We found SILG is a safe, technically feasible, and minimally invasive approach with low incidence of postoperative complication and the best cosmetic result for the patients with MAGV.

Keywords: Laparoscopic gastropexy; Mesentero-axial gastric volvulus; Single incision.

Fig. 1

The wound retractor (Lap Protector®, Hakko Medical, Japan) was inserted, and the silicon cap (EZ access®, Hakko Medical, Japan) was mounted to the retractor. Three 5-mm trocars (EZ trocar®, Hakko Medical, Japan) were placed in the cap (a). After creating a pneumoperitoneum of 6–10 mmHg, a 5-mm, 30° laparoscope was inserted into one of those trocars. Then, laparoscopic exploration confirmed the presence of the gastrosplenic ligaments in all three cases. The anterior wall of the body of the stomach was sutured to the peritoneum using 3-0 non-absorbable sutures (b, c). The first suture was made on the fundus to the diaphragm. The other five sutures were made along the major curve of the stomach. We tried not to create the big space between the sutures for prevention of occurrence of an internal hernia. The scar was very small, and the patients had good cosmetic results (d)

Fig. 2

This figure shows the complication and the concept we need to take care. “A point” gastropexy (a) or “A line” gastropexy (b) may cause the gastric volvulus along the new axis which was made by a point or short range suture or a line suture. Furthermore, when we made the rough interval sutures which have big space between the sutures, an internal hernia can occur between the sutures (c). In our technique, the anterior wall of the body of the stomach was sutured to the peritoneum using six sutures in total for prevention of recurrence of gastric volvulus and occurrence of an internal hernia through the space created between the sutures (d)