Treatment of Gastric Torsion After Sleeve Gastrectomy.

Anthony M Gonzalez, MD, FACS, FASMBS, Christian Hernandez Mucia, MD, Pedro E Garcia Quintero, MD, Rey Romero, MD, Charan Donkor, MD, Jorge R Rabaza, MD, FACS, FASMBS. Baptist Health South Florida.

BACKGROUND: Sleeve Gastrectomy (SG) has been adopted as a stand-alone treatment for morbid obesity due its low morbidity and effectiveness that rivals Roux en-Y-Gastric Bypass (RYGB). Gastric Torsion (GT) after SG is a rare complication and poorly reported. The purpose of this video is to report three cases of GT after SG.

METHODS: Between 2008 and 2013, a total of 295 SG where performed at South Miami Hospital Weight Loss Surgery Program (Baptist Health South Florida); 3 female patients of one single surgeon (AMG) presented with GT after SG. In these three patients, the mean age was 52 years old, the mean body mass index 41.36 kg/m2 and the mean time between SG and GT diagnosis was 111 days. After appropriate testing preoperatively, which included image studies and upper endoscopy, patients were surgically treated (2 robotic and 1 laparoscopic). In every case, intraoperative findings showed GT secondary to adhesions between staple line and the liver, the treatment consisted in lysis of adhesions with or without gastropexy.

OUTCOMES: The recovery was uneventful for all patients, with no GT recurrences. One patient was converted to RYGB for weight loss failure 15 months after SG.

CONCLUSIONS: GT after SG for the treatment of morbid obesity is a rare complication. Endoscopy is the most useful preoperative test. The common finding noted in our cases was adhesions between the staple line and the liver, causing torsion of the sleeve. This complication can be treated safety (robotic or laparoscopic) by lysis of the adhesions with or without gastropexy.

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