Laparoscopic suture gastropexy for gastric volvulus: a report of 14 cases.

BACKGROUND: Gastric volvulus is an uncommon condition that affects mostly older men. It occurs mainly as a result of congenital laxity of the stomach's attachments and might be accompanied by a diaphragmatic hernia. This sometimes causes the stomach to herniate into the thorax, giving rise to respiratory compromise. A patient can have acute or chronic disease. We present our series of 14 patients who were managed with simple laparoscopic suture gastropexy.

METHODS: We managed 14 patients with gastric volvulus during the past ten years; 2 patients had primary type and 12 had secondary type gastric volvulus. Elective surgery was performed for the ten patients with chronic volvulus and emergency surgery was done for the four patients with acute volvulus. One of the patients with diaphragmatic hernia was six months pregnant and presented with acute symptoms.

RESULTS: All patients recovered well from surgery, including the pregnant patient. The average hospital stay was five days; the pregnant woman was discharged on the sixth postoperative day.

DISCUSSION: Symptoms of chronic gastric volvulus resemble those of reflux disease, whereas the acute condition is a surgical emergency. Gastric volvulus is a rare disease, so chances of laparoscopic management are also rare. There are also combined endoscopic and laparoscopic approaches for treatment; even percutaneous endoscopic gastrostomy has been tried with good results. In secondary volvulus, the diaphragmatic defect has to be repaired, preferably with mesh. Gastropexy is performed in all cases.

CONCLUSION: Even though worldwide experience in laparoscopic surgery for gastric volvulus is limited, the results are encouraging. Based on our experience, laparoscopic management seems to be safe and feasible in acute and gastric volvulus.