• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Descriptions and Video Updates
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • COVID-19 Announcements
    • SAGES 2020 Meeting Information
    • 2021 Scientific Session Call For Abstracts
    • 2021 Emerging Technology Session Call For Abstracts
    • 2018 Prevent BDI Consensus Conference
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • Leadership Development and Health Policy Conference Videos
      • SAGES Quality Summit Meeting
      • SAGES 2019
      • SAGES 2018
      • SAGES 2017
      • SAGES 2016
      • SAGES 2015
      • SAGES 2014
      • SAGES 2013
    • Related Meetings Calendar
  • Membership
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • COVID-19 Annoucements
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • Troubleshooting Guides
  • Education
    • SAGES.TV Video Library
    • Virtual Hernia Clinic
    • The SAGES Safe Cholecystectomy Program
    • The Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • The SAGES HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Endorsed Courses
    • SAGES Robotics Fellows Courses
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Educational Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES Quality Initiative
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Research Opportunities
    • SAGES Endorsed Courses
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
    • Fellowship Certification
  • Search
    • COVID-19 Announcements
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Blog
    • All Blog Posts
    • COVID-19
    • Notes from the Battlefield
    • A (Positive) Way Forward
    • President Posts
  • Log In

Laparoscopic Repair of Intrathoracic Stomach in Elderly Symptomatic Patients with No Conversion and Zero Mortality

Althaea Greenstone, MD, Paul Suding, MD, Teresa Kim, MD, Gregory Broderick-Villa, MD, Rupert Horoupian, MD, Steven Stanten, MD, Ajay Upadhyay, MD. Alta Bates Summit Medical Center, Oakland and Berkeley, California & St. Rose Hospital, Hayward, California.

INTRODUCTION
Surgical repair of intrathoracic stomach in the elderly remains controversial. Advanced age with multiple associated co-morbidities is perceived as an increased operative risk leading to major complications including death. Up to 40% mortality in emergent or urgent cases have been reported in the past utilizing a transthoracic, open or laparoscopic approach. We reviewed the utility of a laparoscopic approach in all patients irrespective of an elective or emergent presentation in elderly patients.
METHODS
A prospectively maintained electronic medical record was retrospectively reviewed. This series represents patients age 65 and above presenting with symptomatic intrathoracic stomach, presenting to a single specialty surgery group practice, at a tertiary care hospital, between 2003 and 2010. The clinical charts maintained on an electronic medical record were reviewed retrospectively. Patient demographics, pre-operative symptoms, surgical decision making, operative details, perioperative complications, 30 day mortality and one year mortality were analyzed. All surgeries were performed using laparoscopic or robotic assisted laparoscopic approach.

RESULTS
A total of 29 consecutive patients underwent surgical repair of an intrathoracic stomach at a tertiary care community hospital. There were 20 females (68.9%) and 9 males (31.03%). The age range was between 65-89 years. Seven cases (24.13%) were operated on an emergent basis, 22 (75.86%) underwent elective repair. All 29 cases were completed laparoscopically with no conversions to open surgery. One patient (3.44%) was found to have a partially necrotic stomach requiring a laparoscopic vertical sleeve Gastrectomy. The presenting symptoms included sudden onset of retrosternal chest pain, epigastric pain, vomiting, retching, difficulty in swallowing, gastrointestinal hemorrhage, aspiration pneumonia and circulatory collapse in emergent cases and heartburn, regurgitation, nausea, vomiting, post prandial discomfort, early satiety and shortness of breath in elective cases. One or more pre operative co- morbidities were observed in all patients (hypertension, coronary artery disease, atrial fibrillation, congestive heart failure, dyslipidemia, asthma, COPD and aspiration pneumonia). The length of stay was between 1-18 days. Prolonged ICU stay (>48 hours) was required in five (17.24%) cases. Pneumothorax and pneumomediastinum were observed in three patients (10.34%), with spontaneous resolution in all three patients. There was no 30 day mortality in this series. At one year follow up there was no mortality.

CONCLUSIONS
Many contemporary series in the last decade have utilized laparoscopic approach in up to 85 % of cases and have reported a lowering of mortality to 7-10%, with isolated case series reporting no mortality. However, both open approach and transthoracic approach has been commonly reported, even in the last decade in spite of several studies showing the advantages of the laparoscopic approach. Our series have shown that the laparoscopic repair of intrathoracic stomach in elderly symptomatic patients, including those presenting on an emergent basis can be performed safely. We recommend abandoning the trans-thoracic approach and attempting a laparoscopic approach in all cases including emergent or urgent cases with the exception of a hemodynamically unstable patient.


Session: Poster
Program Number: P263
View Poster

Post Views: 1,699

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2011 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Daniel Herron, MD

An opportunity to slow down and appreciate the small joys in life

Dan Herron, MD shares insights with Dana Telem, MD on lessons learned from COVID-19 Fear, anxiety and uncertainty has dominated the first half of 2020. Never before have we, as healthcare providers, been asked to do so much with so little—whether it’s resources like personal protective equipment, dusting off skills related to critical care, or […]

covid testing stock

Notes from the Battlefield – May 14, 2020

Coronavirus Global Surgical Collaborative (CVGSC)* An initiative sponsored by SAGES in collaboration with EAES, AEC, KSELS, and ELSA A group of surgical leaders from affected countries have joined to discuss what they are learning during this Covid-19 Global crisis. The following is a brief summary of what they feel may be useful information to disseminate to the surgical […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Newsletter Subscription

  • This field is for validation purposes and should be left unchanged.

Important Links

SAGES 2020 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

[footer_backtotop] · Log in

Copyright © 2021 Society of American Gastrointestinal and Endoscopic Surgeons · Legal
· Managed by BSC Management, Inc