From the Research
The treatment of mesentero-axial gastric volvulus requires prompt surgical intervention with laparoscopic gastropexy to prevent life-threatening complications, as evidenced by the most recent study in 2023 1. The surgical approach depends on the patient's condition and may include laparoscopic or open techniques to reduce the volvulus and prevent recurrence.
Key Considerations
- Initial management includes nasogastric tube decompression, fluid resuscitation, and correction of electrolyte abnormalities, followed by definitive surgical repair.
- The primary surgical procedures involve detorsion of the stomach to its normal position, followed by fixation techniques such as anterior gastropexy (suturing the greater curvature to the anterior abdominal wall), fundoplication if a hiatal hernia is present, or gastrostomy tube placement which serves both as a fixation point and allows enteral feeding.
- In cases with gastric necrosis, partial gastrectomy may be necessary.
- For high-risk patients who cannot tolerate surgery, endoscopic reduction may be attempted as a temporizing measure, though this carries a high risk of recurrence.
- Post-operative care includes gradual advancement of diet, proton pump inhibitors (such as pantoprazole 40mg daily for 4-6 weeks), and close monitoring for complications.
Supporting Evidence
- A study published in 2019 2 described the use of single-incision laparoscopic gastropexy for mesentero-axial gastric volvulus, demonstrating its safety and effectiveness.
- Another study in 2022 3 highlighted the importance of prompt surgical intervention in treating mesentero-axial gastric volvulus, using laparoscopic approach.
- The most recent study in 2023 1 further supports the use of laparoscopic gastropexy in treating mesentero-axial gastric volvulus, with successful outcomes and minimal complications.
Clinical Implications
- Prompt treatment is essential as gastric volvulus has a mortality rate of 30-50% if left untreated due to risks of strangulation, ischemia, and perforation.
- Laparoscopic gastropexy is a safe and effective treatment option for mesentero-axial gastric volvulus, with benefits including minimal invasiveness, reduced recovery time, and improved cosmetic results.