Laparoscopic Anterior Gastropexy Research Articles

Comment on "Sutured Versus Mesh-augmented Hiatus Hernia Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials".

Comment on "Sutured Versus Mesh-augmented Hiatus Hernia Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials".

Laparoscopic anterior gastropexy for type III/IV hiatal hernia in elderly patients

IntroductionLarge esophageal hiatal hernias occur most commonly in elderly patients with comorbidities, in whom even an elective surgery cannot be performed without high risks. Although fundoplication is recommended for esophageal hiatal hernia repair, we prefer not to limit our options to fundoplication, as obstruction is a frequent main complaint. We favor an anterior gastropexy approach instead to perform anti-reflux surgery and prevent recurrent protrusion and torsion of the incarcerated organ with minimal risk. The aim was to evaluate the safety and effectiveness of anterior gastropexy for large hiatal hernia in elderly patients with comorbidities.Case presentationWe retrospectively evaluated 8 patients who underwent laparoscopic anterior gastropexy for large hiatal hernia (type III or IV) since 2006. All patients were women with a median age of 82 years (range, 74–87 years). The major complaint was obstruction in all patients, with relatively mild reflux symptoms. They underwent successful laparoscopic surgery with no conversion to laparotomy.Fundoplication was performed in 4 cases. No perioperative complications occurred, and the main complaint resumed rapidly in all patients, without recurrence during postoperative follow-up of median 48 months (range, 5–77 months).ConclusionLaparoscopic anterior gastropexy is safe and effective and can be considered as one of the practical surgical options for large hiatal hernias in elderly patients, whom surgical intervention should be minimized due to their comorbidities.

A rare case of post-splenectomy gastric volvulus managed by laparoscopic anterior gastropexy.

We report an extremely rare case of recurrent gastric volvulus after open splenectomy for hereditary spherocytosis. The initial episode was managed by endoscopic derotation. Later, for recurrent symptoms, she was successfully managed by laparoscopic anterior gastropexy.

Laparoscopic Treatment of Acute Gastric Volvulus

IntroductionGastric volvulus is an uncommon clinical condition and is associated with type II–III hiatal hernias. Its acute presentation constitutes a surgical emergency. Despite its low frequency, results of laparoscopic treatment have already been published. Material and methodsA retrospective study was performed on all cases diagnosed with gastric volvulus undergoing laparoscopic surgery between 1998 and 2010. The surgical technique, the post-operative outcome, and the clinical follow-up are described. ResultsA total of 10 cases were identified, one was a primary gastric volvulus, and the remainder were secondary. A laparoscopic anterior gastropexy as the sole procedure was performed on 7 patients. A Nissen fundoplication with mesh reinforcement of the crural closure was performed on the 3 remaining cases. Postoperative outcome was uneventful in 9 patients, with an early start of the diet, and hospital discharge between 48 and 72h. After a mean follow-up period of 18 months, radiological hernia recurrence occurred in one case but recurrence of the volvulus was not observed. ConclusionLaparoscopic anterior gastropexy is, in our experience, an effective and safe procedure with a low morbidity, for the treatment of acute gastric volvulus in patients with high surgical risk.

Tratamiento del vólvulo gástrico agudo mediante abordaje laparoscópico

IntroductionGastric volvulus is an uncommon clinical condition and is associated with type ii-iii hiatal hernias. Its acute presentation constitutes a surgical emergency. Despite its low frequency, results of laparoscopic treatment have already been published. Material and methodsA retrospective study was performed on all cases diagnosed with gastric volvulus undergoing laparoscopic surgery between 1998 and 2010. The surgical technique, the post-operative outcome, and the clinical follow-up are described. ResultsA total of 10 cases were identified, one was a primary gastric volvulus, and the remainder were secondary. A laparoscopic anterior gastropexy as the sole procedure was performed on 7 patients. A Nissen fundoplication with mesh reinforcement of the crural closure was performed on the 3 remaining cases. Postoperative outcome was uneventful in 9 patients, with an early start of the diet, and hospital discharge between 48-72h. After a mean follow-up period of 18 months, radiological hernia recurrence occurred in one case but recurrence of the volvulus was not observed. ConclusionLaparoscopic anterior gastropexy is, in our experience, an effective and safe procedure with a low morbidity, for the treatment of acute gastric volvulus in patients with high surgical risk.

Laparoscopic anterior gastropexy for chronic recurrent gastric volvulus: a case report

IntroductionGastric volvulus is an uncommon clinical entity, first described by Berti in 1866. It is a rotation of all or part of the stomach through more than 180°. This rotation can occur on the longitudinal (organo-axial) or transverse (mesentero-axial) axis. This condition can lead to a closed-loop obstruction or strangulation. Traditional surgical therapy for gastric volvulus is based on an open approach. Here we report the case of a patient with chronic intermittent gastric volvulus who underwent a successful laparoscopic treatment.Case presentationA 34-year-old woman presented with multiple episodes of recurrent upper abdominal pain associated with retching and vomiting, treated unsuccessfully with intramuscular metoclopramide. Endoscopic examination of the upper digestive tract showed a suspected rotation of the stomach, and a chronic recurrent gastric volvulus was revealed by barium meal. The patient was operated on successfully, with an anterior laparoscopic gastropexy performed as the first surgical approach.ConclusionExperience with laparoscopic anterior gastropexy is limited only to a few described cases. Our patient was clinically and radiologically followed-up for 2 years with no evidence of recurrence, either radiological or symptomatic. Based on this result, laparoscopic gastropexy can be seen and considered as an initial 'gold standard' for the treatment of gastric volvulus.

Percutaneous endoscopic gastrostomy for recurrent gastric volvulus after laparoscopic gastropexy

A 44‐year‐old lady with an acute gastric volvulus was initially treated by laparoscopic anterior gastropexy after gastric decompression and derotation. She developed recurrent volvulus 4 weeks after the initial laparoscopic surgery. Double percutaneous endoscopic gastrostomy (PEG) fixation of the stomach was carried out to prevent recurrent volvulus. Unfortunately, one of the PEG tubes migrated out of the stomach 4 weeks later. Another PEG fixation was carried out on the patient. There has been no recurrence of gastric volvulus 9 months after the removal of the PEG tubes. The reasons of failure in laparoscopic and endoscopic gastropexy are discussed in the present report. Repeated PEG fixation of stomach is a feasible and less invasive option in preventing recurrent gastric volvulus after failure of laparoscopic and endoscopic gastropexy.

Laparoscopic Gastropexy by Abdominal Wall-Lifting Procedure for Acute Gastric Volvulus

We report on a 6-year-old girl with acute gastric volvulus treated successfully with laparoscopic anterior gastropexy by the abdominal wall-lifting technique. The gastrocolic ligament was poorly developed, which allowed mesenterioaxial volvulus. Anterior gastropexy was easily accomplished by direct suturing with extracorporeal knotting under normal pressure. This procedure, which produces a working space sufficient for the gastropexy, is simple, safe, and cost beneficial because there is no requirement for pneumoperitoneum. This experience impressed on us that an intraoperative upper gastrointestinal series should be used to help the surgeon fix the stomach in its anatomically correct position.