title: Management Options for Twisted Gastric Tube after Laparoscopic Sleeve Gastrectomy.
abstract: This study aims to determine the incidence, etiology, and management options for symptomatic gastric obstruction caused by axially twisted sleeve gastrectomy.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Surgery, Mansoura University Hospital, Gihan El Sadat St, Mansoura, Dakahlia, 35511, Egypt. surg_latif@hotmail.com.|Department of Surgery, Hafar Albatin Central Hospital, Hafar Al-Batin, Saudi Arabia. surg_latif@hotmail.com.
authors.forename: Mohamed E
authors.initials: ME
authors.lastname: Abd Ellatif
authors.affiliation: Department of Surgery, Mansoura University Hospital, Gihan El Sadat St, Mansoura, Dakahlia, 35511, Egypt.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Abbas
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, 35511, Egypt.
authors.forename: Ayman
authors.initials: A
authors.lastname: El Nakeeb
authors.affiliation: Department of Surgery, Hafar Albatin Central Hospital, Hafar Al-Batin, Saudi Arabia.
authors.forename: Alaa
authors.initials: A
authors.lastname: Magdy
authors.affiliation: Department of Surgery, Theodore Bilharz Research Institute, Cairo, Egypt.|Bariatric and Metabolic Surgery Center, Hamad Medical Corporation (HMC), Doha, Qatar.
authors.forename: Asaad F
authors.initials: AF
authors.lastname: Salama
authors.affiliation: Bariatric and Metabolic Surgery Center, Hamad Medical Corporation (HMC), Doha, Qatar.
authors.forename: Moataz M
authors.initials: MM
authors.lastname: Bashah
authors.affiliation: Department of Surgery, Mansoura University Hospital, Gihan El Sadat St, Mansoura, Dakahlia, 35511, Egypt.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Dawoud
authors.affiliation: Department of Surgery, Jahra Hospital, 01753, Al-Jahra, Kuwait.
authors.forename: Maged Ali
authors.initials: MA
authors.lastname: Gamal
authors.affiliation: Bariatric and Metabolic Surgery Center, Hamad Medical Corporation (HMC), Doha, Qatar.
authors.forename: Davit
authors.initials: D
authors.lastname: Sargsyan
mesh_terms: D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005743:Gastrectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Dilation; Gastrectomy; Sleeve; Twist