Published online Sep 21, 2013. doi: 10.3748/wjg.v19.i35.5848
Revised: July 26, 2013
Accepted: August 4, 2013
Published online: September 21, 2013
AIM: To evaluate the outcomes of patients who underwent laparoscopic repair of intra-thoracic gastric volvulus (IGV) and to assess the preoperative work-up.
METHODS: A retrospective review of a prospectively collected database of patient medical records identified 14 patients who underwent a laparoscopic repair of IGV. The procedure included reduction of the stomach into the abdomen, total sac excision, reinforced hiatoplasty with mesh and construction of a partial fundoplication. All perioperative data, operative details and complications were recorded. All patients had at least 6 mo of follow-up.
RESULTS: There were 4 male and 10 female patients. The mean age and the mean body mass index were 66 years and 28.7 kg/m2, respectively. All patients presented with epigastric discomfort and early satiety. There was no mortality, and none of the cases were converted to an open procedure. The mean operative time was 235 min, and the mean length of hospitalization was 2 d. There were no intraoperative complications. Four minor complications occurred in 3 patients including pleural effusion, subcutaneous emphysema, dysphagia and delayed gastric emptying. All minor complications resolved spontaneously without any intervention. During the mean follow-up of 29 mo, one patient had a radiological wrap herniation without volvulus. She remains symptom free with daily medication.
CONCLUSION: The laparoscopic management of IGV is a safe but technically demanding procedure. The best outcomes can be achieved in centers with extensive experience in minimally invasive esophageal surgery.
Core tip: Migration of the whole stomach in to the chest cavity by rotating its longitudinal or transverse axis, namely “intra-thoracic gastric volvulus’’, is a very rare type of giant hiatal hernias and is associated with catastrophic complications. Laparoscopic repair of this rare condition is the most technically demanding procedure among the benign foregut surgeries. With careful attention the details, such as total excision of the hernia sac, provision of an adequate esophageal length with full mobilization of the esophagus, tensionless hiatoplasty, and a floppy fundoplication, long-term success is possible