Laparoscopic Management of Gastric Torsion After Sleeve Gastrectomy
Christian Hernandez Murcia, MD, Pedro Garcia Quintero, MD, Jorge Rabaza, MD, FACS, FASMBS, Anthony Gonzalez, MD, FACS, FASMBS
Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA (all authors).
Introduction: Gastric volvulus occurs primarily when the stomach suffers torsion on itself due to laxity, elongation, or agenesis of the stomach ligamentous attachments or secondary to diaphragmatic hernias. Gastric torsion after sleeve gastrectomy is a rare complication. We present a case report of 3 patients with gastric torsion after sleeve gastrectomy.
Case Description/Technique Description: Three patients with gastric torsion after sleeve gastrectomy were identified. Time between sleeve gastrectomy and gastric torsion symptomatology was 25, 211, and 98 days. Endoscopy established the diagnosis in all patients. Operative findings were organoaxial torsion due to adhesions of the sleeve’s staple line to the liver in all cases. Gastropexy was required in 1 case after laparoscopic lysis of adhesions. Recovery was uneventful for all patients, without torsion recurrence.
Discussion: Because sleeve gastrectomy alters the normal stomach attachments, gastric torsion must be considered after sleeve gastrectomy in patients with any degree of obstruction symptoms, at any time of the postoperative course. Endoscopy is a valuable tool for the diagnosis. Laparoscopic torsion reduction by lysis of adhesions is successful, with or without gastropexy.
Key Words: Gastric volvulus, Gastric torsion, Sleeve gastrectomy, Lysis of adhesions, Gastropexy.