Video demonstration of the technique of laparoscopic gastrophrenopexy for the treatment of symptomatic primary organoaxial gastric volvulus.
OBJECTIVE
The aim of this work was to demonstrate the technique of laparoscopic gastrophrenopexy performed for intermittent partial organoaxial volvulus.


METHODS
Two pediatric patients, with an initial presentation of postprandial epigastric discomfort, were investigated by upper gastrointestinal contrast meal. These investigations revealed the presence of a rare variant of primary organoaxial gastric volvulus. Both patients underwent a laparoscopy, which confirmed gastromegaly with redundant gastrophrenic and gastrolienal ligaments. A gastrophrenopexy was performed with initial pexy of, principally, the fundus to the left hemidiaphragm, using interrupted nonabsorbable sutures. The gastrophrenopexy was performed without an esophagocardiopexy or an anterior gastropexy. A video demonstrates the technical aspects of the procedure, and the associated pre- and postoperative imaging for both patients will be presented.


RESULTS
Both procedures were accomplished laparoscopically in less than 60 minutes, with no immediate postoperative complications. The patients were discharged the following day after a period of observation. Symptom resolution occurred with both patients. One patient underwent a repeat upper gastrointestinal contrast study 4 years post intervention, which demonstrated an intact gastropexy.


CONCLUSIONS
Laparoscopic gastrophrenopexy may be utilized for this rare variant of gastric organoaxial volvulus. This technique is durable over the medium term and is, therefore, recommended as the primary intervention in symptomatic pediatric patients.
Nataraja
Ramesh
R
Department of Pediatric Surgery, Royal Alexandra Children's Hospital, Brighton, UK.
Mahomed
Anies
A
D002648:Child; D006801:Humans; D010535:Laparoscopy; D008022:Ligaments / Q000601:surgery; D013270:Stomach / Q000601:surgery; D013277:Stomach Volvulus / Q000601:surgery*; D016896:Treatment Outcome; D014743:Videotape Recording