Laparoscopic Treatment for Pediatric Gastric Volvulus

Abstract

Background and Purpose: Gastric volvulus in children may be a surgical emergency or may present more subtly. The classic symptoms of gastric volvulus include the triad of unproductive retching, epigastric distention, and the inability to pass a nasogastric tube, but these symptoms are inconsistent in children. The accepted surgical treatment for acute, subacute, or intermittent gastric volvulus is anterior gastropexy, and others have reported that this can be accomplished laparoscopically. We present further clinical experience documenting the safety and efficacy of a laparoscopic approach to gastric volvulus. Methods: This is a case series of 4 children (2 girls and 2 boys, ranging in age from 8 months to 12 years) with gastric volvulus. Two presented as emergencies, one was asymptomatic, and one presented with a feeding problem. Results: Gastric volvulus was successfully treated by laparoscopic gastropexy in all cases. Two children also had a gastrostomy tube placed for postoperative feeding. Postoperative hospital stay ranged from 3 to 12 days, the latter due to unrelated medical problems in one child. There were no direct surgical complications or noted recurrence of volvulus. All children were well at follow-up. Conclusion: Our small experience supports laparoscopic gastropexy as a safe and effective treatment for gastric volvulus in children, with no serious complications, and minimal postoperative morbidity.