OGBN P09 Management of acute gastric volvulus: a systematic review and practical guide to management

Abstract

Abstract Background Gastric volvulus can result in a life-threatening clinical course resulting in gastric ischemia. The optimal treatment strategy for gastric volvulus has not been established, hence we performed a systematic review and developed a practical guide to management. Methods A systematic on-line literature search of Embase and Medline identified 1435 articles of which 49 relevant studies were selected, including 32 retrospective studies, 17 case series. Selected articles were assessed by two reviewers to extract data. Results 731 patients with gastric volvulus (76.8% organoaxial, 22.2% mesentericoaxial)were identified with a median age of 40 years, 50% were female. 233 (32%) of patients underwent a laparotomy, 255 (35%) a laparoscopy and 148 (20%) were managed conservatively. Endoscopic decompression was trialled initially in 81 patients and successful in 20 (26.3%) patients. A higher proportion of complications (22.4% versus 4.7%) and recurrence (33% versus 0%) was seen in those who had laparoscopic rather than open repair. A lower 30-day mortality (0% versus 4.7%) and length of stay (3.3 versus 12 days) was noted in the laparoscopic cohort. Conclusions A multimodal approach using endoscopic decompression and placement of an NG tube is vital followed by a prompt decision on definitive surgical intervention. Laparoscopic and open procedures are both possible however lower morbidity and recurrence rates are evident following an open-approach but with a higher associated mortality risk.