Management and Outcomes in Gastric Volvulus: A Tiered Approach
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Authors
Askari, A.
Tezcan, E.
Patel, K.
Adil, M.T.
Munasinghe, A.
Al Taan, O.
Jain, V.
Jambulingam, P.
Rashid, F.
Issue Date
2022
Type
Scientific Paper
Language
Keywords
Research Subject Categories::MEDICINE::Dermatology and venerology,clinical genetics, internal medicine::Internal medicine::Gastroenterology
Alternative Title
Abstract
Introduction Gastric volvulus is a rare yet life-threatening condition requiring urgent attention. In this case series and literature review, we present the difficulties in management and outcome in patients with gastric volvulus and suggest a tiered framework to guide management. All consecutive cases at a single institution presenting between January 1, 2010, and June 30, 2020, were included. Chi-squared analyses were undertaken to compare outcomes across different groups. A total of 48 patients presented with gastric volvulus; the median age was 78 years (interquartile range [IQR]: 69–84) and 70.8% were female. Most patients had an ASA score of III (n = 19/48, 39.6%) or IV (n = 14/48, 29.2%). In total, 62.5% (n = 30/48) underwent laparoscopic surgery and mesh was used in 40.0%. Eighteen patients (37.5%) were not suitable candidates for surgery or declined surgery. The median length of stay in those undergoing surgery was 4 days (IQR: 2–6). The complication rate in this cohort was 26.7% (n = 8/30). Of these eight patients, four had postoperative nausea, and four others suffered from pneumothorax, wound hematoma, intra-abdominal bleeding, or intra-abdominal collection. The patient who had a serious intra-abdominal bleed returned to operating room and required blood transfusions on day 1 postsurgery. The readmission rate in the surgery group was 6.6% (n = 2/30), both of who had prolonged nausea and were treated symptomatically. The overall 30-day morality in the surgical group was 3.3%. Over a follow-up period of 37 months, 10.0% had a recurrence of hernia, all of who were managed conservatively. Gastric volvulus is a surgical emergency that is associated with a high rate of morbidity and mortality. A tiered treatment algorithm based on urgency can help deliver timely treatment and standardize care. One in 10 patients post–gastric volvulus repair will have recurrence of para-oesophageal hernia but can be treated conservatively.
Keywords
gastric volvulus - laparoscopy - laparoscopic surgery
Authors' Contribution
The authors confirm that they all contributed significantly to this study to justify their authorship.
Publication History
Received: 28 September 2020
Accepted: 26 April 2022
Article published online:
24 August 2022
© 2022. Thieme. All rights reserved.
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Description
Citation
Digestive Disease Interventions 2022; 06(04): 323-330 DOI: 10.1055/s-0042-1750048