Introduction: Laparoscopic repair of a large hiatal hernia with fundoplication is a procedure that may have significant morbidity in an old and high-risk patient. High recurrence rates after laparoscopic repair have been reported. Intra-thoracic stomach complicated by gastric volvulus consist a surgical emergency that, if untreated, will lead to mortality. We propose an alternative, minimally invasive approach that minimizes the extent of dissection and morbidity while providing good anatomical and functional results.
Case report: We present a case series of three high-risk patients who presented with gastric volvulus. These patients were treated with emergent laparoscopic reduction of gastric volvulus with three point fixation gastropexy. All patients made an uneventful recovery. Their symptoms resolved and remain asymptomatic at midterm follow-up. Description of this novel technique and swallow radiograms are presented.
Discussion: As opposed to crural dissection and repair with fundoplication, laparoscopic reduction of volvulus with gastropexy offers a less invasive solution with good symptomatic relief at midterm follow-up. We suggest that the described technique may be a preferred option for high-risk patients. Larger study with longer follow-up is warranted to determine its application.
Program Number: P244