Management Options for Twisted Gastric Tube after Laparoscopic Sleeve Gastrectomy

• Published in: Obesity surgery Vol. 27; no. 9; pp. 2404 - 2409
• Main Authors: Abd Ellatif, Mohamed E., Abbas, Ashraf, El Nakeeb, Ayman, Magdy, Alaa, Salama, Asaad F., Bashah, Moataz M., Dawoud, Ibrahim, Gamal, Maged Ali, Sargsyan, Davit
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-09-2017; Springer Nature B.V
• Subjects: Digestive System Surgical Procedures - adverse effects; Digestive System Surgical Procedures - methods; Digestive System Surgical Procedures - statistics & numerical data; Endoscopy; Gastrectomy - adverse effects; Gastrectomy - statistics & numerical data; Gastrointestinal surgery; Humans; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - statistics & numerical data; Medicine; Medicine & Public Health; Obesity; Obesity, Morbid - surgery; Original Contributions; Postoperative Complications - epidemiology; Postoperative Complications - surgery; Retrospective Studies; Surgery; Surgical outcomes; Treatment Outcome; Twist; Dilation; Sleeve; Gastrectomy
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-017-2649-y

Purpose
This study aims to determine the incidence, etiology, and management options for symptomatic gastric obstruction caused by axially twisted sleeve gastrectomy.
Methods
In this retrospective study, we reviewed medical charts of all morbidly obese patients who underwent laparoscopic sleeve gastrectomy. Patients who developed gastric obstruction symptoms and were diagnosed with twisted sleeve gastrectomy were identified and included in this study.
Results
From October 2005 to December 2015, there are 3634 morbidly obese patients who underwent laparoscopic sleeve gastrectomy (LSG). Eighty-six (2.3%) patients developed symptoms of gastric obstruction. Forty-five (1.23%) patients were included in this study. The mean time of presentation was 59.8 days after surgery. Upper GI contrast study was done routinely, and it was positive for axial twist in 37 (82%) patients. Abdominal CT with oral and IV contrast was done in eight (18%) when swallow study was equivocal. Endoscopic treatment was successful in 43 patients (95.5%). Sixteen patients were successfully managed by endoscopic stenting, and 29 patients had balloon dilation. The average numbers of dilation sessions were 1.7. Out of these 29 patients, 18 responded well to a single session of dilatation and did not require any further dilatation sessions. Two patients who failed to respond to three subsequent sessions of balloon dilation underwent laparoscopic adhesiolysis and gastropexy.
Conclusions
Endoscopic stenting is an effective tool in management of axial rotation of sleeved stomach. Balloon dilation can also be effective in selected cases. Few cases might require laparoscopic adhesiolysis and gastropexy.