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Management Options for Twisted Gastric Tube after Laparoscopic Sleeve Gastrectomy

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Abstract

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.

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Authors and Affiliations

  1. Department of Surgery, Mansoura University Hospital, Gihan El Sadat St, Mansoura, Dakahlia, 35511, Egypt

    Mohamed E. Abd Ellatif, Ashraf Abbas & Ibrahim Dawoud

  2. Department of Surgery, Hafar Albatin Central Hospital, Hafar Al-Batin, Saudi Arabia

    Mohamed E. Abd Ellatif & Alaa Magdy

  3. Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, 35511, Egypt

    Ayman El Nakeeb

  4. Department of Surgery, Theodore Bilharz Research Institute, Cairo, Egypt

    Asaad F. Salama

  5. Bariatric and Metabolic Surgery Center, Hamad Medical Corporation (HMC), Doha, Qatar

    Asaad F. Salama, Moataz M. Bashah & Davit Sargsyan

  6. Department of Surgery, Jahra Hospital, 01753, Al-Jahra, Kuwait

    Maged Ali Gamal

Authors
  1. Mohamed E. Abd Ellatif
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  2. Ashraf Abbas
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  3. Ayman El Nakeeb
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  4. Alaa Magdy
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  5. Asaad F. Salama
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  6. Moataz M. Bashah
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  7. Ibrahim Dawoud
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  8. Maged Ali Gamal
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  9. Davit Sargsyan
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Corresponding author

Correspondence to Mohamed E. Abd Ellatif.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures in the study were performed in accordance with the Institutional Research Board (IRB) Committee.

Informed Consent

Informed consent was obtained from all individuals who participated in the study.

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Abd Ellatif, M.E., Abbas, A., El Nakeeb, A. et al. Management Options for Twisted Gastric Tube after Laparoscopic Sleeve Gastrectomy. OBES SURG 27, 2404–2409 (2017). https://doi.org/10.1007/s11695-017-2649-y

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  • DOI: https://doi.org/10.1007/s11695-017-2649-y

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