A Comparison of Clinical Outcomes Between Two Different Models of Surgical Robots in Roux-en-Y Gastric Bypass.

Introduction: For the past 20 years, robotic surgical systems have been used for the Roux-en-Y gastric bypass (RYGB). The da Vinci Surgical System (Intuitive Surgical, Inc.) has been one of the most used robotic platforms. This study aims to retrospectively compare the performance of two models of surgical robots. Materials and Methods: A retrospective comparative study was conducted from a prospective database including all patients who underwent robotic RYGB (RRYGB) from 2011 to 2020. Results: Of a total of 277 patients included, 134 were in the RRYGB using the da Vinci S™ (RRYGB-S™) group and 143 were in the RRYGB using the da Vinci Xi™ (RRYGB-Xi™) group. The mean operative time in the RRYGB-S and RRYGB-Xi groups was 154 ± 28 and 151 ± 32 minutes, respectively (P = .510). The was no statistically significant difference in terms of intraoperative complications between the groups with regard to positive blue test, bleeding, and failure of stapler line. The readmission rate was higher in the RRGB-S group (14.1%) than in the RRYGB-Xi group (3.4%) (P = .004), and it was mainly due to major complications (P = .003) including pouch and gastrojejunostomy anastomotic leaks (P = .001). The nonsurgical complications were statistically significantly higher in the RRYGB-S group (7.4%) than in the RRYGB-Xi group (2.1%) (P < .05), as well as the surgical complications were higher in the RRYGB-S group (7.5%) than in the RRYGB-Xi group (0%) (P < .001). The mean percentage of the total weight loss at 1 and 2 years of follow-up did not show any statistically significant difference (P = .547). Conclusions: The higher complication rate in the S surgical system might be correlated with the initial learning curve and stressed the need for proper robotic surgical training and accurate strategies when introducing emerging technologies into the surgical practice.

NOTES: Transvaginal endoscopic cholecystectomy in humans-preliminary report of a case series.

OBJECTIVES: Natural orifice translumenal endoscopic surgery (NOTES) represents an emerging technology, including under its umbrella a variety of approaches and combinations. The transvaginal approach to endoscopic cholecystectomy is one such technique, which we present here as a small series. METHODS: From May to November 2007, a total of eight patients were scheduled to undergo transvaginal endoscopic cholecystectomy at our institute. Two patients were excluded as they were converted to laparoscopy due to technical difficulties. RESULTS: Average age of the patients was 34.5 years, and mean body mass index was 27 kg/m(2). The mean operating time was 148.5 min. Patients were discharged in an average of four postoperative days. The major complication rate was 16% (1/6). The patient with a major complication had a subhepatic collection that was managed with ultrasonogram-guided aspiration followed by ERCP and stenting. CONCLUSIONS: Since the first description of NOTES, there has been no standardized technique. In our technique, we used a single 3-mm trocar for visualizing the entry and exit of the endoscope, maintaining and measuring pneumoperitoneum, and retracting the gall bladder fundus. The instruments that were used were the conventional endoscopic ones. The transvaginal approach seems to be a viable alternative to the transgastric approach for cholecystectomy, as the transgastric approach has certain inherent problems like leakage from the gastrotomy site and poor ergonomy. The downside to the transvaginal approach is that it is possible only in women.

Laparoscopic repair of adult diaphragmatic hernias and eventration with primary sutured closure and prosthetic reinforcement: a retrospective study.

BACKGROUND: Diaphragmatic hernias may be congenital or acquired (traumatic). Some patients present in adulthood with a congenital hernia undetected during childhood or due to trauma, known as the adult-onset type. The authors present their series of adult-onset type diaphragmatic hernias managed successfully by laparoscopy. METHODS: This study retrospectively investigated 21 adult patients between 1995 and 2007 who underwent laparoscopic repair at the authors' institution, 15 of whom were symptomatic. Laparoscopic repair was performed with mesh for 18 patients and without mesh for three patients who had Morgagni hernia. RESULTS: In this series, Bochdalek hernia (n = 12), Morgagni hernia (n = 3), eventration (n = 3), and chronic traumatic hernia (n = 3) were treated. Intercostal drainage was required for 14 patients, whereas in three cases the hypoplastic lung never reinflated even after surgery. The time of discharge was in the range of postoperative days 4 to 9. The complication rate was 19%, and mortality rate was 4.5%. One case of recurrence was noted after 10 months. CONCLUSION: The controversies involved are the surgical approach, management of the hernial sac, whether or not to suture the defect, and choice of prosthesis. Although laparoscopic and thoracoscopic approaches are comparable, the laparoscopic approach seems to have certain distinct advantages. The authors prefer not to excise the hernial sac and favor suturing the defects before mesh reinforcement. Regarding the type of mesh used, composite, expanded polytetrafluoroethylene (ePTFE), or polypropylene are the available options. Laparoscopic repair is feasible, effective, and reliable. It could become the gold standard in the near future.

Laparoscopic management of an obstructing granulocytic sarcoma of the jejunum causing intussusception in a nonleukemic patient: report of a case.

Granulocytic sarcoma is an extramedullary tumor of immature myeloid cells which is often a forerunner to the development of acute myelogenous leukemia. Granulocytic sarcoma of the gastrointestinal tract frequently involves the small intestine and often presents with abdominal pain and obstruction. Our patient presented with a proximal jejunal mass causing intussusception and obstruction. This type of manifestation has never before been reported. A laparoscopy-assisted resection of the affected portion of jejunum was performed for him. The initial pathological findings were high-grade non-Hodgkin's lymphoma; immunohistochemistry confirmed a diagnosis of granulocytic sarcoma. After a follow-up of 14 months, there was no evidence of leukemia. This condition is often mistaken for lymphoma and confirmation is necessary by immunohistochemistry. Chemotherapy is the treatment of choice and surgery is indicated only in the event of complications, such as bowel obstruction, bleeding, or perforation. The prognosis of granulocytic sarcoma is similar to that of myeloid leukemia.

Complicated Meckel's diverticulum in pediatrics: role of laparoscopy-two rare cases.

Meckel's diverticula are mostly asymptomatic. Even complicated disease is hardly diagnosed preoperatively and hence met with fatal outcomes, if not intervened on immediately. In this paper, we present 2 pediatric cases with complicated Meckel's diverticula that were diagnosed and successfully treated by the totally laparoscopic approach. To the best of our knowledge such cases have not been reported in the literature, so far. Nevertheless, we caution about keeping a high index of suspicion for diagnosing such pediatric cases and stress the need for an early laparoscopy in them.

Laparoscopic antrectomy for a proximal duodenal Brunner gland hamartoma.

BACKGROUND: Adenoma is the most common cause of duodenal polyps, while hamartomas are very rare. We present a patient with a preoperative histology proved diagnosis of isolated duodenal tubulovillous adenomatous polyp with high-grade dysplasia for whom we performed laparoscopic antrectomy. CASE REPORT: The patient was a 56-year-old male with vague upper abdominal pain. Investigations revealed a 3-cm x 3-cm mass arising from the duodenal mucosa with no evidence of extraserosal spread. Histopathology documented an adenomatous polyp with high-grade dysplasia, so a laparoscopic antrectomy was performed. RESULTS: The patient had an uneventful postoperative period, requiring only 2 doses of parenteral analgesics. He was discharged on the seventh postoperative day. The final histopathological findings were consistent with benign hamartoma. No recurrence has been reported after 14 months of follow-up with endoscopy. DISCUSSION: Many procedures have been described for polyps, such as endoscopic excision, duodenectomy, pancreatoduodenectomy, and laparoscopic polyp excision. In our patient, the decision to perform duodenectomy was based on the preoperative findings of a sessile tubulovillous adenomatous polyp with high-grade dysplasia. Histologically, the 2 entities can be identical, especially with the small tissue volume obtained from endoscopic biopsy. CONCLUSION: Given these observations, antrectomy was probably ideal, because endoscopic excision would have been inadequate and even dangerous while pancreatoduodenectomy would have been too radical.

An innovative technique for colorectal specimen retrieval: a new era of "natural orifice specimen extraction" (N.O.S.E).

PURPOSE: The common incisions for transabdominal specimen retrieval after laparoscopic colorectal surgery are lower quadrant, midline, or transverse suprapubic incision. This study was designed to evaluate a novel method of specimen extraction after totally laparoscopic proctocolectomies. METHODS: We retrospectively studied seven women patients from 2004 to 2007. The indication for surgery was familial polyposis coexisting with adenocarcinoma of the upper rectum. A totally laparoscopic proctocolectomy with ileal pouch-anal anastomosis was successfully performed for all cases. The entire specimen was extracted via a transvaginal route. RESULTS: The mean age of the patients was 49.5 years, and mean body mass index was 25.3 kg/m(2). The mean operating time was 222.5 minutes, and average blood loss was 172 ml. The average hospital stay was 25.5 days. Postoperative complications included ileus (n = 1), pouchitis (n = 1), and deep vein thrombosis (n = 1). The vaginal wound had healed completely by the first follow-up. There was no mortality. CONCLUSIONS: Our technique of transvaginal retrieval effectively prevents wound-related complications by completely eliminating minilaparotomies for specimen retrieval. It could be called "Natural Orifice Specimen Extraction," or N.O.S.E. We stress the need for innovations in specimen extraction, for which importance is not given by surgeons.

Combined thoracoscopic and endoscopic management of mid-esophageal benign lesions: use of the prone patient position : Thoracoscopic surgery for mid-esophageal benign tumors and diverticula.

BACKGROUND: Both benign tumors and mid-esophageal diverticula are rare conditions; underlying disorders may be present in case of diverticula. Traditionally, thoracotomy was the preferred route to approach these lesions. Now, more surgeons are using minimally invasive techniques to treat these benign mid-esophageal lesions. PATIENTS AND METHODS: A total of 12 patients with symptomatic mid-esophageal lesions were studied, benign tumors were seven cases and five cases of diverticula. We present our experiences with thoracoscopic enucleation of benign tumors and diverticulectomy aided by peroperative endoscopy. All the patients were placed in the prone position and approached via a right thoracotomy. RESULTS: Two patients had minor complications of pneumonitis and dysphagia, which were treated conservatively. One patient had a leak from the staple line that needed a second-look thoracoscopy and evacuation of abscess. DISCUSSION: In this study, we highlight the use of the prone patient position, the advantages of a right thoracoscopic approach and the value of peroperative endoscopy. The prone position was first described in 1994, but has not been popular. Peroperative endoscopy accurately localizes diverticula and determines level of stapler application. CONCLUSION: Thoracoscopy has definite benefits regarding reduced morbidity. The combined modality of peroperative endoscopy is useful in diverticulectomy. Based on our experience, we believe the prone patient position is the ideal position for esophageal surgery.

Transvaginal endoscopic appendectomy in humans: a unique approach to NOTES--world's first report.

BACKGROUND: Natural orifice translumenal endoscopic surgery (NOTES) is the newest technique emerging in the field of surgery. There are several techniques described in the literature; however there is no standardization yet. We describe the transvaginal approach for endoscopic appendectomy in humans, probably the world's first report. MATERIALS AND METHODS: Pneumoperitoneum was achieved via a Veress needle in the umbilicus. Routine 12-mm endoscope and routine instruments were used. Peritoneal access was gained via a transvaginal approach through the posterior fornix. RESULTS: Out of a total of six patients, a totally endoscopic transvaginal appendectomy was successfully performed for one patient. The other five patients were either converted to conventional laparoscopy or aided by a laparoscope. The average age of the patients was 29.5 years. The mean operating time was 103.5 min. Hospital stay was 1-2 days. The follow-ups were scheduled at 7 days, 30 days, 90 days, and 6 months. The vaginal wound was examined by the gynecologist and found to have completely healed during the first and second follow-up. DISCUSSION: So far in humans, transgastric appendectomy and cholecystectomy, and transvaginal cholecystectomy have been reported. A transvaginal endoscopic appendectomy in humans has not been reported yet. The transvaginal approach provided a normal image of the target organ, unlike the inverted image of a transgastric approach caused by the inability to manipulate the scope outside the mouth. The technical ease of the procedure and early outcome seem satisfactory, although comparative studies are needed to confirm this.

Laparoscopic right hemicolectomy for goblet-cell carcinoid of the appendix: report of a rare case and literature survey.

Tumors of the appendix are rare entities, and the majority of them are discovered accidentally during an investigation for other conditions. Laparoscopic surgery for appendiceal goblet-cell carcinoid (GCC) has only been reported once before. Our patient was incidentally discovered to have an appendiceal tumor and was referred to us for laparoscopy. The tumor involved the body of the appendix and was adherent to the cecum. A laparoscopic hemicolectomy was successfully performed for the patient. Postoperative recovery was uneventful. Histopathology confirmed an appendiceal goblet-cell carcinoid. Immunohistochemistry was negative for the neuroendocrine markers, CK20 and CK7. GCC is a rare tumor of the appendix. Hemicolectomy is indicated in specific situations, such as local involvement or tumor size >2 cm. In our patient, the tumor was adherent to the cecum and tumor size was 5 cm. Therefore, a laparoscopic right hemicolectomy was performed primarily. There are several reports in the literature supporting both the laparoscopic and open approaches. Laparoscopic surgery for appendiceal tumors is safe, feasible, and even may be beneficial.

Minimally invasive therapy for benign tumors of the distal third of the esophagus--a single institute's experience.

INTRODUCTION: Traditionally, the treatment of benign esophageal tumors is enucleation achieved via a thoracotomy. Since 1992, many reports of thoracoscopic and laparoscopic approaches have been published. In this paper, we present a retrospective study of 18 patients with benign distal esophageal tumors who underwent minimally invasive procedures. MATERIALS AND METHODS: A total of 18 patients were treated in our institute form 1994 to 2006. Tumors of the middle third were approached thoracoscopically, and laparoscopic transhiatal enucleation was performed for tumors of the lower third. One patient had associated achalasia cardia, for which a cardiomyotomy with Toupet fundoplication was also performed, and another patient underwent an esophagectomy for a large tumor. RESULTS: There were 12 males and 6 females and the average age was 59 years. The majority of the tumors were in the lower third, and the most common type of tumor was leiomyoma. Postoperative complications were recorded. DISCUSSION: Leiomyomas are the most common benign tumors and are located frequently in the middle and lower third. Based on our experience, we feel that lower esophageal tumors are best approached by a laparoscopic transhiatal route and midesophageal tumors by a right thoracoscopic approach. CONCLUSIONS: Minimally invasive surgery for benign esophageal tumors is ideal, reducing the morbidity of conventional methods.

Laparoscopic and perineal excision of an infected "dumb-bell" shaped retrorectal epidermoid cyst.

INTRODUCTION: Extraperitoneal cysts in the pelvis adjacent to the rectum are rare entities. They are of vague etiology, and the pathologic types of the acquired variety are dermoid, epidermoid, and teratoma. As far as we know, laparoscopic excision of a retrorectal epidermoid cyst has never before been reported. CASE REPORT: The patient was an elderly lady with a large pelvic cyst and another large cyst in the perineum, which displaced the vagina and the anus. Laparoscopy was performed; the pelvic cyst was punctured and then dissected out. The perineal extension of the cyst was excised via a perineal approach. The patient had an uneventful recovery and was discharged on the 4th postoperative day. Histopathologically, the cyst was of the epidermoid type. Follow-up after 26 months revealed no recurrence. DISCUSSION: Our case presented a diagnostic dilemma. Laparoscopic excision was tedious, though we completed the procedure successfully. Precaution was taken to avoid spillage of the contents and also to avoid injury to vital structures nearby, such as the iliac vessels and ureter. It is feasible to laparoscopically excise retrorectal cysts with a careful and meticulous dissection. CONCLUSIONS: The major advantages are rapid recovery with minimal morbidity and excellent cosmesis.

Transumbilical endoscopic appendectomy in humans: on the road to NOTES: a prospective study.

BACKGROUND: Natural orifice translumenal endoscopic surgery (NOTES) is the newest technique emerging in the field of surgery. There are several techniques described in the literature, though there is no standardization yet. In this paper, we describe a transumbilical approach for the endoscopic appendectomy in humans. MATERIALS AND METHODS: Eight of 12 patients with uncomplicated appendicitis successfully underwent a transumbilical endoscopic appendectomy. Patients with a mass, abscessed or perforated appendix, previous lower abdominal surgeries, and conversion to laparoscopy (4 patients) were excluded. RESULTS: The average age of the patients was 32.5 years. The mean operating time was 95 minutes, and the conversion rate was 33.3%. Only 1 dose of intravenous analgesics was administered postoperatively. Hospital stay was 1-3 days. The follow-ups were scheduled at 7, 30, and 90 days and 8 months. Six patients completed all the follow-ups and experienced no problems. DISCUSSION: So far, this transumbilical approach to the appendectomy in humans has not been reported. We think that this method of approach is an effective technique by itself and an ideal "stepping stone" to NOTES, as well as helpful to train laparoscopic surgeons to make the transition to full-fledged NOTES. Unlike the transgastric or transvaginal approaches, the umbilical approach allows an easy maneuverability of the endoscope, though at the cost of an umbilical scar. The technical ease of the procedure and early outcome seem satisfactory. This technique may be considered as a "precursor" to NOTES.

Minimally invasive surgery combined with peroperative endoscopy for symptomatic middle and lower esophageal diverticula: a single institute's experience.

INTRODUCTION: Esophageal diverticula are rare, accounting for less than 5% of dysphagia cases. Midesophageal and epiphrenic esophageal diverticula account for about 30% of all esophageal diverticula. Traditionally, thoracotomy or laparotomy were the preferred approaches for surgical therapy. Recently, minimally invasive therapies have been described. MATERIALS AND METHODS: We present our experiences of 12 patients with diverticula of the distal two-thirds of the esophagus. Thoracoscopic approach was used to treat midesophageal diverticula and a transhiatal approach was used for the epiphrenic diverticula. Peroperative endoscopy was used in all cases. Underlying causes were also simultaneously dealt with. DISCUSSION: According to our series, epiphrenic diverticula were more common; lateral wall being the most common location. Myotomy and fundoplication were done depending on the underlying disorder. We highlight the importance of peroperative endoscopy to accurately localize and determine extent of diverticulectomy. RESULTS: Males were more common than females and most patients were elderly. Postoperatively, 2 cases had complications and 1 patient had leak. The length of hospital stay was 3 to 23 days. CONCLUSIONS: Esophageal diverticula are rare conditions, and minimally invasive surgery is certainly feasible and effective in terms of reduced morbidity.

Thoracoscopic retrieval of a "smiling" foreign body from the proximal esophagus: an impacted denture.

BACKGROUND: The esophagus is a common site for foreign bodies (FBs) because of areas of physiologic narrowing. Dentures pose special problems, especially if they are impacted. We present a case of a "smiling" foreign body in the proximal esophagus. CASE REPORT: The patient was an 80-year-old man with a history of dysphagia and swallowed dentures. Thoracoscopic removal was performed successfully as an endoscopic removal had failed and the patient had an uneventful postoperative recovery. He was discharged on the seventh postoperative day. DISCUSSION: Coins are the most commonly ingested FBs. Swallowing of dentures is found mostly in elderly patients. If endoscopic removal is not possible, then a minimally invasive surgery is an alternative. Swallowing of dentures is rare, and its thoracoscopic removal has not been reported so far. Using thoracoscopy, all the benefits of a minimally invasive surgery can be used. CONCLUSIONS: Minimally invasive techniques have been found to be very useful in the removal of intraluminal FBs, especially when conservative measures fail. Prevention of such incidents should be emphasized.

Laparoscopic right hemicolectomy for mucocele due to a low-grade appendiceal mucinous neoplasm.

Tumors of the appendix are rare entities causing mucoceles. The majority of them are discovered incidentally during investigation for other conditions. Laparoscopic surgery for appendiceal tumors is still controversial, as inadvertent rupture of the lesion due to improper handling will cause pseudomyxoma peritonei. The patient was incidentally discovered to have an appendiceal tumor and referred to us for laparoscopy. Because the tumor involved the entire appendix, a laparoscopic right hemicolectomy was performed without directly handling the tumor. Postoperative recovery was uneventful. Pathological diagnosis was low-grade appendiceal mucinous neoplasm. The safety of laparoscopic appendectomy for the management of incidentally discovered appendiceal tumors has not yet been established. Several reports in the literature support both laparoscopic and open surgery. The main concerns to be addressed are the adequacy of resection and intraperitoneal rupture of the tumor. Our patient successfully underwent laparoscopic surgery without any complications. A formal right hemicolectomy was performed because the tumor involved the entire appendix. We now think laparoscopic surgery for appendiceal tumors is safe, feasible, and even may be beneficial.

Laparoscopic management of symptomatic Meckel's diverticula: a simple tangential stapler excision.

BACKGROUND: Meckel's diverticulum was first described about 400 years ago and continues to be a rare congenital disorder. Laparoscopic surgery for Meckel's diverticulum has been described in mostly case reports. We present our series of patients with symptomatic Meckel's diverticulum. METHODS: We have treated 12 patients with symptomatic Meckel's diverticulum from 1994 through 2006 at our institution. All the patients presented with features of either appendicitis or peritonitis, some with a vague abdominal mass. Clinical diagnosis of Meckel's diverticulum was made in only 4 patients. Diagnostic laparoscopy confirmed Meckel's diverticulitis in all patients. Laparoscopic stapler resection of the lesions was performed for all patients, tangential excision in 10 and wedge excision in 2. RESULTS: The incidence of Meckel's diverticulum at our institution is 0.3%. The majority of patients were male children. There were no staple-line leaks in any case. All patients recovered well postoperatively, and the day of discharge was in the range of the fourth to the seventh POD. Heterotopic gastric mucosa was found in the majority of the diverticula. Eight patients were followed up for 24 months, and 4 patients reported for follow-up after 45 months and were found to be symptom-free. DISCUSSION: The diagnosis of Meckel's diverticulitis is rarely made preoperatively. Surgical resection is indicated only if the diverticulum is symptomatic or if the base is narrow. Traditionally, open wedge resection (including the anterior wall of the ileum) of the diverticulum is the treatment. We think that a simple tangential stapler resection can also be performed, with good outcome. CONCLUSION: Laparoscopy is useful in both diagnosis and treatment. Laparoscopic resection of Meckel's diverticulum is feasible and ideal, especially when performed in specialized centers.

Laparoscopic management of a retroperitoneal duodenal perforation following ERCP for periampullary cancer.

INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) is a fairly common procedure being performed in several centers worldwide. Although it is proven to be efficient and relatively safe, complications do occur (1.8%). We present a patient with ERCP-induced retroperitoneal perforation of the duodenum treated laparoscopically at our institution. CASE REPORT: The patient is a 60-year-old female who underwent ERCP for obstructive jaundice due to periampullary carcinoma, during which the perforation occurred. Laparoscopy was performed 5 hours later and the perforation sutured primarily. RESULTS: The operating time was 125 minutes. On the fourth postoperative day, the patient developed a retroperitoneal collection, confirmed by computed tomographic scan. Re-look laparoscopy was performed and the fluid drained. She recovered completely and was discharged on the eighth postoperative day. CONCLUSION: Duodenal perforation following ERCP is rare, with an incidence of 1.8%. Both surgical and non-surgical management have been reported, each with its specific indications. Our patient needed surgery, because the perforation was large and a retroperitoneal collection was present. Laparotomy is the preferred approach, though now laparoscopy is a viable and effective alternative, because it provides the benefits of minimal access, such as reduced pain and early ambulation.

Emergency laparoscopic cholecystectomy for acute empyema of the gallbladder in pregnancy.

Laparoscopic surgery in pregnant patients have been reported in the literature, laparoscopic cholecystectomy being the most common. A pregnant patient in her second trimester of pregnancy underwent emergency laparoscopic cholecystectomy for empyema of gallbladder. The distended gallbladder was decompressed before dissection was commenced. There was no morbidity conversion, or complications for either mother or child related to general anaesthesia. The major advantages of the minimally invasive therapy can be utilized in the surgical disorders of the pregnant patient.

Laparoscopic suture gastropexy for gastric volvulus: a report of 14 cases.

BACKGROUND: Gastric volvulus is an uncommon condition that affects mostly older men. It occurs mainly as a result of congenital laxity of the stomach's attachments and might be accompanied by a diaphragmatic hernia. This sometimes causes the stomach to herniate into the thorax, giving rise to respiratory compromise. A patient can have acute or chronic disease. We present our series of 14 patients who were managed with simple laparoscopic suture gastropexy. METHODS: We managed 14 patients with gastric volvulus during the past ten years; 2 patients had primary type and 12 had secondary type gastric volvulus. Elective surgery was performed for the ten patients with chronic volvulus and emergency surgery was done for the four patients with acute volvulus. One of the patients with diaphragmatic hernia was six months pregnant and presented with acute symptoms. RESULTS: All patients recovered well from surgery, including the pregnant patient. The average hospital stay was five days; the pregnant woman was discharged on the sixth postoperative day. DISCUSSION: Symptoms of chronic gastric volvulus resemble those of reflux disease, whereas the acute condition is a surgical emergency. Gastric volvulus is a rare disease, so chances of laparoscopic management are also rare. There are also combined endoscopic and laparoscopic approaches for treatment; even percutaneous endoscopic gastrostomy has been tried with good results. In secondary volvulus, the diaphragmatic defect has to be repaired, preferably with mesh. Gastropexy is performed in all cases. CONCLUSION: Even though worldwide experience in laparoscopic surgery for gastric volvulus is limited, the results are encouraging. Based on our experience, laparoscopic management seems to be safe and feasible in acute and gastric volvulus.