Gastric volvulus after sleeve gastrectomy for morbid obesity

Abstract

Laparoscopic sleeve gastrectomy in morbid obesity has proved to be a safe and reproducible technique. Sleeve gastrectomy, however, is not free of complications. On the other hand, gastric volvulus is reported in those subjects where, either because of laxity of the gastric anatomical fixations or incorrect position of the stomach, rotation or turning is facilitated. We report the case of a patient with morbid obesity (Bone mass index / BMI 63 Kg/m2), who in the post-operative period immediately following a sleeve gastrectomy, presented early symptoms of upper gastrointestinal occlusion indicative of gastric volvulus of the gastric sleeve. The patient developed a partial obstruction secondary to a mixed volvulus mechanism (organo-axial and partially mesenteric-axial) after sleeve gastrectomy. We performed a laparoscopic antrectomy of the gastric sleeve and then a gastroileal anastomosis, a form of biliopancreatic diversion, with a common channel of 80 cm and alimentary limb of 160 cm). 18 months after, the patient has a BMI of 28 kg/m2 and enjoys a good quality of life. Sleeve gastrectomy leaves the stomach with no fixations along the entire greater curvature, which may predispose to volvulus. This complication is a rare finding and not reported to date following this intervention, but still needs to be considered in this type of patient.