title: Laparoscopic management of totally intra-thoracic stomach with chronic volvulus.
abstract: OBJECTIVE
  To evaluate the outcomes of patients who underwent laparoscopic repair of intra-thoracic gastric volvulus (IGV) and to assess the preoperative work-up.
  
  
  METHODS
  A retrospective review of a prospectively collected database of patient medical records identified 14 patients who underwent a laparoscopic repair of IGV. The procedure included reduction of the stomach into the abdomen, total sac excision, reinforced hiatoplasty with mesh and construction of a partial fundoplication. All perioperative data, operative details and complications were recorded. All patients had at least 6 mo of follow-up.
  
  
  RESULTS
  There were 4 male and 10 female patients. The mean age and the mean body mass index were 66 years and 28.7 kg/m(2), respectively. All patients presented with epigastric discomfort and early satiety. There was no mortality, and none of the cases were converted to an open procedure. The mean operative time was 235 min, and the mean length of hospitalization was 2 d. There were no intraoperative complications. Four minor complications occurred in 3 patients including pleural effusion, subcutaneous emphysema, dysphagia and delayed gastric emptying. All minor complications resolved spontaneously without any intervention. During the mean follow-up of 29 mo, one patient had a radiological wrap herniation without volvulus. She remains symptom free with daily medication.
  
  
  CONCLUSIONS
  The laparoscopic management of IGV is a safe but technically demanding procedure. The best outcomes can be achieved in centers with extensive experience in minimally invasive esophageal surgery.
authors.affiliation: Toygar Toydemir, Mehmet Ali Yerdel, Department of General Surgery, Istanbul Surgery Hospital, 34365 İstanbul, Turkey.
authors.forename: Toygar
authors.initials: T
authors.lastname: Toydemir
authors.forename: Gökhan
authors.initials: G
authors.lastname: Çipe
authors.forename: Oğuzhan
authors.initials: O
authors.lastname: Karatepe
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Yerdel
mesh_terms: D000368:Aged; D002908:Chronic Disease; D005260:Female; D018662:Fundoplication; D006551:Hernia, Hiatal / Q000000981:diagnostic imaging / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013277:Stomach Volvulus / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Hiatal hernia; Laparoscopic procedure; Mesh repair; Stomach; Volvulus