Evaluation of biomechanical traction of incisional gastropexy and scarification gastropexy techniques in dogs

Background: Gastropexy is used to correct gastric dilatation volvulus, a disease that usually affects large and giant dogsand leads to death in 23.4 - 43% of patients. This study aimed to evaluate the biomechanical traction of 2 gastropexytechniques, incisional gastropexy and scarified gastropexy, in 10 dog cadavers. Incisional gastropexy comprises a singleincision in the abdominal wall and another incision in the stomach wall in the pyloric region followed by simple continuous sutures. The scarification technique creates scarification along the stomach borders of the pexy. Thereby, knowing thatboth techniques are successful, the biomechanical traction of each technique was compared.Materials, Methods & Results: A total of 10 animals without defined breed weighing from 6.4 - 43.0 kg were allocatedinto 2 equal groups (GE [scarified gastropexy] and GI [incisional gastropexy]). Incisional gastropexy was performed witha simple continuous suture pattern in the GI group and scarified gastropexy with an interrupted simple suture pattern wasperformed in the GE group. Absorbable 2-0 monofilament yarn (polygllecaprone 25) was used for sutures in both groups.Rectangular segments of the gastric antrum were collected from the right abdominal wall and from the bottom of thestomach at the left abdominal wall, which were subjected to a traction test. The scarification technique was easier, faster,and used less surgical sutures than the incisional technique. Both techniques were effective regardless of the site applied,with no significant differences. There was a difference in stretching depending on location.Discussion: The pathogenesis of gastric dilatation volvulus (GDV) is unknown. However, gas accumulation inside thegastric chamber may lead to organ dilation and consequently cause torsion of the cardia region and pyloric antrum, resulting in strangulation of blood vessels and nerves. This torsion could cause stomach ischemia followed by organ necrosis if...(AU)

Evaluation of biomechanical traction of incisional gastropexy and scarification gastropexy techniques in dogs

Background: Gastropexy is used to correct gastric dilatation volvulus, a disease that usually affects large and giant dogsand leads to death in 23.4 - 43% of patients. This study aimed to evaluate the biomechanical traction of 2 gastropexytechniques, incisional gastropexy and scarified gastropexy, in 10 dog cadavers. Incisional gastropexy comprises a singleincision in the abdominal wall and another incision in the stomach wall in the pyloric region followed by simple continuous sutures. The scarification technique creates scarification along the stomach borders of the pexy. Thereby, knowing thatboth techniques are successful, the biomechanical traction of each technique was compared.Materials, Methods & Results: A total of 10 animals without defined breed weighing from 6.4 - 43.0 kg were allocatedinto 2 equal groups (GE [scarified gastropexy] and GI [incisional gastropexy]). Incisional gastropexy was performed witha simple continuous suture pattern in the GI group and scarified gastropexy with an interrupted simple suture pattern wasperformed in the GE group. Absorbable 2-0 monofilament yarn (polygllecaprone 25) was used for sutures in both groups.Rectangular segments of the gastric antrum were collected from the right abdominal wall and from the bottom of thestomach at the left abdominal wall, which were subjected to a traction test. The scarification technique was easier, faster,and used less surgical sutures than the incisional technique. Both techniques were effective regardless of the site applied,with no significant differences. There was a difference in stretching depending on location.Discussion: The pathogenesis of gastric dilatation volvulus (GDV) is unknown. However, gas accumulation inside thegastric chamber may lead to organ dilation and consequently cause torsion of the cardia region and pyloric antrum, resulting in strangulation of blood vessels and nerves. This torsion could cause stomach ischemia followed by organ necrosis if...

Management of paraesophageal hernia review of clinical studies: timing to surgery, mesh use, fundoplication, gastropexy and other controversies.

Despite paraesophageal hernias (PEH) being a common disorder, several aspects of their management remain elusive. Elective surgery in asymptomatic patients, management of acute presentation, and other technical aspects such as utilization of mesh, fundoplication or gastropexy are some of the debated issues. The aim of this study was to review the available evidence in an attempt to clarify current controversial topics. PEH repair in an asymptomatic patient may be reasonable in selected patients to avoid potential morbidity of an emergent operation. In acute presentation, gastric decompression and resuscitation could allow to improve the patient's condition and refer the repair to a more experienced surgical team. When surgical repair is decided, laparoscopy is the optimal approach in most of the cases. Mesh should be used in selected patients such as those with large PEH or redo operations. While a fundoplication is recommended in the majority of patients to prevent postoperative reflux, a gastropexy can be used in selected cases to facilitate postoperative care.

Síndrome da dilatação vólvulo-gástrica em cães - revisão de literatura

A síndrome da dilatação vólvulo-gástrica consiste no aumento do diâmetro do estômago associado à rotação em seu eixo mesentérico. Caracterizada por ser de etiologia multifatorial, a DVG ocorre devido acúmulo de gás e fluído no estômago. Os sinais clínicos são clássicos à patologia, possibilitando um diagnóstico preciso através do exame clínico e radiográfico. O tratamento clínico é importante, porém a terapia cirúrgica é recomendada em praticamente todos os casos com o objetivo de reparo e profilaxia quanto a futuros desenvolvimentos, a escolha da técnica cirúrgica varia de acordo com o cirurgião. Medidas profiláticas são bastante relevantes principalmente em animais predispostos.

The volvulo-gastric dilatation syndrome consists of increasing the diameter of the stomach associated with rotation in its mesenteric axis. Characterized as being of multifactorial etiology, DVG occurs due to the accumulation of gas and fluid in the stomach. The clinical signs are classic to the pathology, allowing an accurate diagnosis through clinical and radiographic examination. Clinical treatment is important, but surgical therapy is recommended in practically all cases for the purpose of repair and prophylaxis for future developments, the choice of surgical technique varies according to the surgeon. Prophylactic measures are quite relevant mainly in predisposed animals.

Síndrome da dilatação vólvulo-gástrica em cães - revisão de literatura

A síndrome da dilatação vólvulo-gástrica consiste no aumento do diâmetro do estômago associado à rotação em seu eixo mesentérico. Caracterizada por ser de etiologia multifatorial, a DVG ocorre devido acúmulo de gás e fluído no estômago. Os sinais clínicos são clássicos à patologia, possibilitando um diagnóstico preciso através do exame clínico e radiográfico. O tratamento clínico é importante, porém a terapia cirúrgica é recomendada em praticamente todos os casos com o objetivo de reparo e profilaxia quanto a futuros desenvolvimentos, a escolha da técnica cirúrgica varia de acordo com o cirurgião. Medidas profiláticas são bastante relevantes principalmente em animais predispostos.(AU)

The volvulo-gastric dilatation syndrome consists of increasing the diameter of the stomach associated with rotation in its mesenteric axis. Characterized as being of multifactorial etiology, DVG occurs due to the accumulation of gas and fluid in the stomach. The clinical signs are classic to the pathology, allowing an accurate diagnosis through clinical and radiographic examination. Clinical treatment is important, but surgical therapy is recommended in practically all cases for the purpose of repair and prophylaxis for future developments, the choice of surgical technique varies according to the surgeon. Prophylactic measures are quite relevant mainly in predisposed animals.(AU)

A novel percutaneous magnetically guided gastrostomy technique without endoscopy or imaging guidance: a feasibility study in a porcine model.

BACKGROUND: In order to simplify a percutaneous gastrostomy procedure and avoid the need of endoscopy or imaging methods, a novel percutaneous magnetically guided gastrostomy (PMG) technique was conceived. The aim of the present study is to evaluate the feasibility of a novel PMG technique with no endoscopy or any imaging guidance in a porcine model. METHODS: Fourteen crossbred domestic pigs were used for prototype development (cadaveric experiments) and proof-of concept, survival study. The magnetic device was conceived using commercially available rare-earth neodymium-based magnets. The experimental design consisted of developing an internal magnetic gastric tube prototype to be orally inserted and coupled to an external magnet placed on the skin, which facilitated stomach and abdominal wall apposition for blind percutaneous gastrostomy tube placement. Then, a gastrostomy tube was percutaneously and blindly placed. RESULTS: Twelve procedures were undertaken in animal cadavers and two in live models. The technique chosen consisted of using a magnetic gastric tube prototype using six 1 × 1-cm-ring magnets attached to its end. This device enabled successful magnetic coupling with a large (5 cm in diameter) magnet disc placed on the skin. For gastric tube placement, a direct trocar insertion allowed easier and safer placement of a gastric tube as compared to a needle-guide-wire dilation (Seldinger-based) technique. Gastropexy was added to avoid early gastric tube displacement. This novel PMG technique was feasible in a live model experiment. CONCLUSIONS: A novel magnetically guided percutaneous gastrostomy tube insertion technique without the use of endoscopy or image-guidance was successful in a porcine model. A non-inferiority experimental controlled study comparing this technique to percutaneous endoscopic gastrostomy is needed to confirm its efficacy and safety.

Recidiva de dilatação-vólvulo gástrica em Mastiff Inglês três meses após gastropéxia incisional / Recurrence of gastric dilatation-volvulus in a English Mastiff three months after incisional gastropexy / Recaída de dilatación-vólvulo gástrica en Mastín Inglés tres meses después de gastropexia incisional

A dilatação-vólvulo gástrica é comum em raças grandes de tórax profundo. Alterações como hipomotilidade podem gerar dilatação gástrica e sucessivas dilatações subclínicas podem levar a dilatação-vólvulo gástrica pelo esgarçamento dos ligamentos gástricos. O tratamento de eleição, após estabilização do paciente, é o reposicionamento e gastropexia. Dentre as várias técnicas existentes, a gastropexia incisional é de rápida execução e suas taxas de recidiva são baixas. Neste trabalho relatamos o caso de uma cadela de raça Mastiff Inglês com recidiva de dilatação-vólvulo gástrica 3 meses após gastropexia incisional.

The gastric dilatation-volvulus is common in large-breed deep-chested dogs. Changes in gastrointestinal motility can lead to gastric dilatation and successive subclinical gastric dilatation can lead to a gastric dilatation-volvulus by the stretching of gastric ligament. The treatment of choice, after the patient in clinically stabilized, is the reposition of the stomach to its normal position followed by pyloric gastropexy. Among the various existents techniques, the incisional gastropexy has the fastest execution with lower recurrence rates. In this study we report a recurrence gastric dilatation-volvulus in a English Mastiff bitch three months after a pyloric incisional gastropexy.

La dilatación-vólvulo gástrica es común en perros de razas grandes de tórax profundo. Alteraciones como hipomotilidad pueden generar dilatación gástrica, y sucesivas dilataciones subclínicas pueden llevar a la dilatación-vólvulo gástrica por el estiramiento de los ligamentos gástricos. El tratamiento de elección, después dela estabilización dei paciente, es el reposicionamiento y la gastropexia. Entre las varias técnicas existentes, la gastropexia incisional es de rápida ejecución y sus tasas de recaída son bajas. En este trabajo informamos el caso de una perra de raza Mastín Inglés con recaída de dilatación-vólvulo gástrica 3 meses después de gastropexia incisional.

Recidiva de dilatação-vólvulo gástrica em Mastiff Inglês três meses após gastropéxia incisional / Recurrence of gastric dilatation-volvulus in a English Mastiff three months after incisional gastropexy / Recaída de dilatación-vólvulo gástrica en Mastín Inglés tres meses después de gastropexia incisional

A dilatação-vólvulo gástrica é comum em raças grandes de tórax profundo. Alterações como hipomotilidade podem gerar dilatação gástrica e sucessivas dilatações subclínicas podem levar a dilatação-vólvulo gástrica pelo esgarçamento dos ligamentos gástricos. O tratamento de eleição, após estabilização do paciente, é o reposicionamento e gastropexia. Dentre as várias técnicas existentes, a gastropexia incisional é de rápida execução e suas taxas de recidiva são baixas. Neste trabalho relatamos o caso de uma cadela de raça Mastiff Inglês com recidiva de dilatação-vólvulo gástrica 3 meses após gastropexia incisional.(AU)

The gastric dilatation-volvulus is common in large-breed deep-chested dogs. Changes in gastrointestinal motility can lead to gastric dilatation and successive subclinical gastric dilatation can lead to a gastric dilatation-volvulus by the stretching of gastric ligament. The treatment of choice, after the patient in clinically stabilized, is the reposition of the stomach to its normal position followed by pyloric gastropexy. Among the various existents techniques, the incisional gastropexy has the fastest execution with lower recurrence rates. In this study we report a recurrence gastric dilatation-volvulus in a English Mastiff bitch three months after a pyloric incisional gastropexy.(AU)

La dilatación-vólvulo gástrica es común en perros de razas grandes de tórax profundo. Alteraciones como hipomotilidad pueden generar dilatación gástrica, y sucesivas dilataciones subclínicas pueden llevar a la dilatación-vólvulo gástrica por el estiramiento de los ligamentos gástricos. El tratamiento de elección, después dela estabilización dei paciente, es el reposicionamiento y la gastropexia. Entre las varias técnicas existentes, la gastropexia incisional es de rápida ejecución y sus tasas de recaída son bajas. En este trabajo informamos el caso de una perra de raza Mastín Inglés con recaída de dilatación-vólvulo gástrica 3 meses después de gastropexia incisional.(AU)

Prophylactic Gastropexy Incorporating a Gastrotomy Incision in Dogs: A Retrospective Study of 21 Cases (2011-2013).

The objective of this retrospective study was to report any complications associated with incorporating a gastrotomy incision into a right-sided incisional prophylactic gastropexy. The medical records of dogs that underwent a gastrotomy for the removal of gastric foreign material and had a prophylactic right-sided incisional gastropexy performed at the gastrotomy site between April 2011 and February 2013 were reviewed. Two wk postoperative recheck examination and suture removal reports were reviewed and owners were contacted via phone and e-mail for long-term follow-up. In total, 21 cases were reviewed, 19 with long-term follow-up. No complications of the surgery were reported. We concluded that a prophylactic right-sided incisional gastropexy could successfully be performed incorporating the gastrotomy site without significant complications.

Associated laparoscopic-assisted gastropexy and ovariohisterectomy in a Great Dane bitch / Associação de gastropexia e ovariohisterectomia vídeo assistida em cadela Dogue Alemão

Gastropexy techniques are performed aiming to adhere permanently the stomach to the abdomen, being this one of the most common indications for prevention and treatment of gastric dilatation-volvulus (GDV). The only accepted method for the prevention of GDV is the prophylactic gastropexy, and the laparoscopic-assisted procedure is quick and easy to perform. It is aimed to report the association of laparoscopic-assisted prophylactic gastropexyand elective ovariohysterectomy (OVH) in a two years old Great dane bitch using the two-portals access, when it was observed rapid and complete recovery. It is concluded that the two portals laparoscopic-assisted prophylactic gastropexy is feasible and safe in dogs, when combined with elective OVH. It makes the technique a suitable option for prevention of GDV in predisposed breeds.(AU)

As técnicas de gastropexia são realizadas objetivando aderir o estômago permanentemente ao abdômen, sendo comumente indicadas na prevenção e tratamento da dilatação vólvulo-gástrico (DVG). O único método aceito para a prevenção da GDV é a gastropexia profilática, a qual pode ser realizada pelo acesso videoassistido de forma rápida e fácil. Objetiva-se relatar a associação de gastropexia profilática videoassistida e ovariohisterectomia (OVH) eletiva em uma cadela Dogue alemão, com dois anos de idade, pela técnica de dois portais, na qual se observou rápida e completa recuperação da paciente. Conclui-se que a gastropexiavideoassistida profilática associada à OVH videoassistida com dois portais, durante única intervenção, é factível e segura para cães, tornando-se uma opção adequada na prevenção da DVG em raças predispostas.(AU)

Evaluation of single port access gastropexy and ovariectomy using articulating instruments and angled telescopes in dogs.

OBJECTIVE: To describe in dogs, a technique for single port access gastropexy and ovariectomy (SPAGO) using a commercially available multitrocar port and to evaluate short-term outcome. DESIGN: Retrospective case series. ANIMALS: Dogs (n = 18). PROCEDURES: A commercially available multitrocar port was inserted into the abdomen lateral to the rectus abdominis muscle and 2-5 cm caudal to the right rib. Dogs were tilted 45° in both left and right recumbency and bilateral ovariectomy performed using articulating graspers, a bipolar vessel sealing device and a 30° telescope. The laparoscopic assisted incisional gastropexy was performed after ovariectomy at the multitrocar port insertion site by grasping the antral portion of the stomach with a 10 mm DuVall forceps and suturing the seromuscular layer of the antral region of the stomach to the transversus abdominis muscle. RESULTS: Eighteen dogs (median weight, 34.5 kg; range, 14.7-59.2 kg) met the inclusion criteria. Median surgical time for SPAGO was 65 minutes (range, 50-225 minutes). Intra-operative complications included, incorrect multitrocar port placement location (n = 3) and mild hemorrhage from a splenic laceration (1) All dogs recovered from surgery and were discharged from the hospital. CONCLUSIONS: Single port access gastropexy and ovariectomy is a feasible procedure to provide prophylaxis against gastric dilation-volvulus and a simultaneous means of sterilization in female dogs. Careful and accurate initial multitrocar port insertion is necessary to have optimal operative viewing as well as to reduce the chances of inadvertent splenic laceration.

Laparoscopic treatment of obese patients with gastroesophageal reflux disease and Barrett's esophagus: a prospective study.

BACKGROUND: Short-segment Barrett's esophagus (SSBE) or long-segment Barrett's esophagus (LSBE) is the consequence of chronic gastroesophageal reflux disease (GERD), which is frequently associated with obesity. Obesity is a significant risk factor for the development of GERD symptoms, erosive esophagitis, Barrett's esophagus, and esophageal adenocarcinoma. Morbidly obese patients who submitted to gastric bypass have an incidence of GERD as high as 50% to 100% and Barrett's esophagus reaches up to 9% of patients. METHODS: In this prospective study, we evaluate the postoperative results after three different procedures--calibrated fundoplication + posterior gastropexy (CFPG), fundoplication + vagotomy + distal gastrectomy + Roux-en-Y gastrojejunostomy (FVDGRYGJ), and laparoscopic resectional Roux-en-Y gastric bypass (LRRYGBP)--among obese patients. RESULTS: In patients with SSBE who submitted to CFPG, the persistence of reflux symptoms and endoscopic erosive esophagitis was observed in 15% and 20.2% of them, respectively. Patients with LSBE were submitted to FVDGRYGJ or LRRYGBP which significantly improved their symptoms and erosive esophagitis. No modifications of LESP were observed in patients who submitted to LRRYGBP before or after the operation. Acid reflux diminished after the three types of surgery were employed. Patients who submitted to LRRYGBP presented a significant reduction of BMI from 41.5 ± 4.3 to 25.7 ± 1.3 kg/m(2) after 12 months. CONCLUSIONS: Among patients with LSBE, FVDGRYGJ presents very good results in terms of improving GERD and Barrett's esophagus, but the reduction of weight is limited. LRRYGBP improves GERD disease and Barrett's esophagus with proven reduction in body weight and BMI, thus becoming the procedure of choice for obese patients.

New "introducer" PEG-gastropexy with T fasteners: a pilot study.

CONTEXT: Enteral feeding is indicated for patients unable to maintain appropriate oral intake, and percutaneous endoscopic gastrostomy (PEG) is the most adequate long-term enteral access. Peristomal infections are the most common complications of PEG, occurring in up to 8% of patients, despite the use of prophylactic antibiotics. The "introducer" PEG-gastropexy technique avoids PEG tube passage through the oral cavity, preventing microorganisms' dislodgment to the peristomal site. OBJECTIVES: To compare the incidence of peristomal wound infection at 7-day post-procedure after conventional "pull" technique versus a new "introducer" PEG-gastropexy kit. Secondary outcomes included success rates, procedure time, and other complications. METHODS: Eighteen patients referred for PEG placement between June and December 2010 were randomly assigned to "pull" PEG with antibiotics or "introducer" PEG-gastropexy technique without antibiotics. RESULTS: Overall success rate for both methods was 100%, although mean procedure duration was higher in the "introducer" PEG-gastropexy group (12.6 versus 6.4 minutes, P = 0.0166). Infection scores were slightly higher in patients who underwent "pull" PEG with antibiotics compared with "introducer" PEG-gastropexy without antibiotics (1.33 ± 0.83 versus 0.75 ± 0.67, P = 0.29). CONCLUSION: Although procedure duration was longer in the "introducer" PEG-gastropexy, infection scores were marginally higher in the "pull" PEG technique.

New "introducer" PEG-gastropexy with T fasteners: a pilot study / Gastrostomia endoscópica percutânea pela técnica de introdução com gastropexia com T-tags: um estudo piloto

CONTEXT: Enteral feeding is indicated for patients unable to maintain appropriate oral intake, and percutaneous endoscopic gastrostomy (PEG) is the most adequate long-term enteral access. Peristomal infections are the most common complications of PEG, occurring in up to 8 percent of patients, despite the use of prophylactic antibiotics. The "introducer" PEG-gastropexy technique avoids PEG tube passage through the oral cavity, preventing microorganisms' dislodgment to the peristomal site. OBJECTIVES: To compare the incidence of peristomal wound infection at 7-day post-procedure after conventional "pull" technique versus a new "introducer" PEG-gastropexy kit. Secondary outcomes included success rates, procedure time, and other complications. METHODS: Eighteen patients referred for PEG placement between June and December 2010 were randomly assigned to "pull" PEG with antibiotics or "introducer" PEG-gastropexy technique without antibiotics. RESULTS: Overall success rate for both methods was 100 percent, although mean procedure duration was higher in the "introducer" PEG-gastropexy group (12.6 versus 6.4 minutes, P = 0.0166). Infection scores were slightly higher in patients who underwent "pull" PEG with antibiotics compared with "introducer" PEG-gastropexy without antibiotics (1.33 ± 0.83 versus 0.75 ± 0.67, P = 0.29). CONCLUSION: Although procedure duration was longer in the "introducer" PEG-gastropexy, infection scores were marginally higher in the "pull" PEG technique.

CONTEXTO: A nutrição enteral está indicada para pacientes incapazes de manter aporte voluntário adequado e a gastrostomia endoscópica percutânea (GEP) é a via preferencial para acesso enteral de longa duração. As infecções periostomais são as principais complicações da GEP, ocorrendo em até 8 por cento dos pacientes, a despeito do uso de antibiótico profilático. A GEP pela técnica de introdução com gastropexia evita a passagem da sonda de gastrostomia pela cavidade oral, prevenindo contra o deslocamento de microorganismos ali presentes até o sítio da ostomia. OBJETIVO: Comparar a incidência de infecção periostomal no 7º dia após GEP por técnica de tração versus GEP pela técnica de introdução com gastropexia. Objetivos secundários incluíram: taxa de sucesso, tempo de procedimento e outras complicações. MÉTODOS: Dezoito pacientes encaminhados ao setor de endoscopia do Hospital Albert Einstein, São Paulo, SP, para realização de GEP entre junho e dezembro de 2010, foram randomizados para realização de gastrostomia pela técnica de tração com antibioticoterapia profilática ou pela técnica de introdução com gastropexia sem antibiótico profilaxia. RESULTADOS: A taxa de sucesso para ambos os métodos foi de 100 por cento, apesar do tempo do procedimento ter sido mais longo no grupo da técnica de introdução (12,6 versus 6,4 min, P = 0,0166). Os índices de infecção foram discretamente superiores no grupo de GEP por tração, com antibioticoterapia profilática, em comparação ao grupo GEP por introdução com gastropexia (1,33 ± 0,83 versus 0,75 ± 0,67, P = 0,29). CONCLUSÃO: Apesar da duração do procedimento ter sido mais longa no grupo GEP por introdução com gastropexia, a taxa de infecção foi discretamente mais elevada no grupo GEP por tração.

Peristomal infection in percutaneous endoscopic gastrostomy (PEG): a comparative study of two gastropexy techniques in a before-and-after design.

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) performed using the Pull technique is associated with a high rate of surgical infections. When PEG is performed using the Introducer technique, a lower rate of infection is seen. However, this technique can pose technical difficulties during gastropexy. Gastropexy using two straight needles, our initial method, causes the snare to be in contact with the sterile suture. We have recently used an original gastropexy technique performed with a long curved needle in which there is no contamination of the sterile suture. The aim of this study is to compare the rates of infection observed with these two methods of gastropexy. METHODS: The Introducer technique was performed in all patients with two different gastropexy techniques used during two separate, consecutive periods. Antibiotic prophylaxis was not used during either procedure. Any surgical infections were treated with local wound care and/or antibiotic therapy with treatment based on the severity of the infection. The surgical infection rates in each group were compared. RESULTS: Group I consisted of 142 patients who underwent gastropexy with two straight needles, and group II consisted of 435 patients on whom gastropexy was performed with a curved needle. The infection rates found in groups I and II were 2.8% and 0.2%, respectively (P = 0.03). CONCLUSIONS: Gastropexy performed with a curved needle was associated with a lower rate of infection when compared to gastropexy performed with two straight needles.

Laparoscopic gastropexy for the treatment of gastric volvulus / Gastropexia laparoscópica para o tratamento do volvo gástrico

Context - gastric volvulus is an acquired, life-threatening condition in which the stomach rotates upon itself. Objective - to describe the application of laparoscopic gastropexy in the case of severe gastric volvulus presentedby an elderly female. Method - a 69 year old woman presenting severe abdominal pain with, retching and the incapacity to vomit, small dysphagia and sensation of post-prandial fullness was admitted to Hospital São Lucas de Governador Valadares, Brazil. Following clinical examination, the patient was submitted to plain and contrast x-rays of the abdomen and chest, computed tomography of the abdomen and upper gastrointestinal endoscopy. Laparoscopic gastropexy was performed in which the diaphragmatic hernia was reduced, the hiatus sutured, and anti-adhesive polypropylene mesh applied for fixation of the stomach. Results - the clinical, radiological and imaging features were typical of gastric volvulus. Rotation of the stomach was successfully corrected by laparoscopy and the patient was discharged from hospital three days after surgery. One month later, the patient was totally asymptomatic with respect to the igestive tract. Conclusions - an adult female patient suffering from acute gastric volvulus was successfully treated using a laparoscopic approach applied ten days after admission to hospital. Early diagnosis and the prompt surgical correction of such cases are crucial in reducing mortality in gastric volvulus.

Contexto- volvo gástrico é uma condição adquirida, com risco de vida, na qual o estômago sofre um deslocamento em torno de seu eixo. Objetivo- relatar a aplicação de gastropexia laparoscópica numa paciente idosa, apresentando volvo gástrico grave. Método- uma mulher de 69 anos de idade, apresentando dor abdominal severa, náusea e incapacidade de vomitar, pequena disfagia e sensação de plenitude pós-prandial foi admitida no Hospital São Lucas de Governador Valadares, Brasil. Após o exame clínico, foram realizadas radiografias do abdômen e peito (simples e de contraste), juntamente com tomografia de endoscopia superior. Após o diagnóstico, a paciente foi submetida à laparoscopia. A hérnia do diafragma foi reduzida junto com sutura hiatal, além da aplicação de uma tela de polipropileno anti-aderente para fixação do estômago. Resultados- as características clínicas, radiológicas e de imagem revelaram um volvulus gástrico típico. A rotação do estômago foi corrigida com sucesso através de laparoscopia e a paciente foi liberada do hospital após três dias da operação. Um mês após a cirurgia, a paciente encontrava-se totalmente assintomática no que diz respeito ao trato digestivo. Conclusões- uma paciente adulta, sofrendo de volvo gástrico agudo, foi tratada com sucesso através de procedimento laparoscópico realizado dez dias após a internação hospitalar. O diagnóstico precoce e a correção cirúrgica breve são essenciais para a redução da mortalidade em casos de volvo gástrico.