Laparoscopic Gastropexy for Gastric Volvulus in High-Operative-Risk Patients

H. Alejandro Rodriguez-Garcia, MD; Mark R. Wendling, MD; Brant K. Oelschlager, MD

November 16, 2016

Operative Technique

Patient positioning and port placement are similar to our approach to PEH repair, which has been described previously,but the ports are placed at least 5 cm caudal to the location for PEH repair (Figure 2).

Figure 2. Port locations for PEH repair (rectangles) and gastropexy (circles).

This position allows access to the esophageal hiatus for reduction of hernia contents and provides space in the mid-abdomen to place multiple gastropexy sutures. With the volvulus reduced and the stomach in its normal anatomic position, 2-0 silk sutures are placed every 2-3 cm to sequentially attach the stomach to the right crus, diaphragm, and anterior abdominal wall.

In our experience, we initially routinely placed a percutaneous gastrostomy tube along the greater curvature, but we found that a majority of patients did not require a tube for enteral nutrition. Thus, we currently reserve placement of a gastrostomy tube for patients at high risk of inability for oral intake.

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Video: Laparoscopic gastropexy for gastric volvulus.

Summary

Laparoscopic PEH repair is the preferred approach for the definitive treatment of gastric volvulus. In high-operative-risk patients, however, laparoscopic gastropexy offers resolution of obstructive symptoms without the need for prolonged general anesthesia.

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References

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Cite this: Laparoscopic Gastropexy for Gastric Volvulus in High-Operative-Risk Patients - Medscape - Nov 16, 2016.

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