title: Gastric remnant twist in the immediate post-operative period following laparoscopic sleeve gastrectomy.
abstract: Twist of stomach remnant post sleeve gastrectomy is a rare entity and difficult to diagnose pre-operatively. We are reporting a case of gastric volvulus post laparoscopic sleeve gastrectomy, which was managed conservatively. A 38-year-old lady with a body mass index of 54 underwent laparoscopic sleeve gastrectomy. Sleeve gastrectomy was performed over a 32 French bougie using Endo-GIA tri-stapler. On post-operative day 1, patient had nausea and non-bilious vomiting. An upper gastrointestinal gastrografin study on post-operative days 1 and 2 revealed collection of contrast in the fundic area of stomach with poor flow distally, and she vomited gastrograffin immediately post procedure. With the suspicion of a stricture in the mid stomach as the cause, the patient was taken back for a exploratory laparoscopy and intra-operative endoscopy. We found a twist in the gastric tube which was too tight for the endoscope to pass through. This was managed conservatively with a long stent to keep the gastric tube straight and patent. The stent was discontinued in 7 d and the patient did well. In laparoscopic sleeve gastrectomy the stomach is converted into a tube and is devoid of its supports. If the staples fired are not aligned appropriately, it can predispose this stomach tube to undergo torsion along its long axis. Such a twist can be avoided by properly aligning the staples and by placing tacking sutures to the omentum and new stomach tube. This twist is a functional obstruction rather than a stricture; thus, it can be managed by endoscopy and stent placement.
authors.affiliation: Gokulakkrishna Subhas, Anupam Gupta, Mubashir Sabir, Vijay K Mittal, Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI 48075, United States.
authors.forename: Gokulakkrishna
authors.initials: G
authors.lastname: Subhas
authors.affiliation: Gokulakkrishna Subhas, Anupam Gupta, Mubashir Sabir, Vijay K Mittal, Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI 48075, United States.
authors.forename: Anupam
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Gokulakkrishna Subhas, Anupam Gupta, Mubashir Sabir, Vijay K Mittal, Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI 48075, United States.
authors.forename: Mubashir
authors.initials: M
authors.lastname: Sabir
authors.affiliation: Gokulakkrishna Subhas, Anupam Gupta, Mubashir Sabir, Vijay K Mittal, Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI 48075, United States.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Mittal
keywords: Gastric remnant; Obesity; Sleeve gastrectomy; Stent; Volvulus