Gastropexy as a primary approach in the management of post-sleeve gastric twist

Introduction
Bariatric surgery is one of the most effective means of treating severe obesity, constituting more than 46% of the performed bariatric surgery in the past 5 years. Despite its advantages, complications of laparoscopic sleeve gastrectomy may be fatal if not diagnosed early and managed well. Gastric twist is a recognized serious complication of sleeve laparoscopic sleeve gastrectomy. The current management includes repeated endoscopic dilatation and stenting or conversion to Roux-en-Y gastric bypass. Gastric fixation is a novel approach as a primary management of gastric twist.
Aim
Our study aims at introducing gastric fixation as a primary management of gastric twist after sleeve gastrectomy.
Patients and methods
A total of 24 patients (12 men and 12 women) presenting with gastric twist were treated using laparoscopic gastric fixation of the gastric tube. Patients with organic stricture and hiatus hernia were excluded. Gastropexy was performed using proline 2-0 in three stitches: between the left crus of diaphragm and posterior part of upper sleeve, between pancreatic fascia and midbody, and between posterior antrum and mesocolon. In some cases, two more stitches were used to fix the posterior antrum to the mesocolon.
Results
The patients underwent gastropexy with an average operative time of 67 min. Following the procedure, the mean time of symptom resolution was 7±5 days (2–12 days). Recovery was uneventful in all patients, and success rate was 99.0%, with neither post-procedure complications nor recurrence of twist in the 2-month follow-up of the patients.
Conclusion
Gastric fixation is a relatively safe, easy, and cost-effective one-time procedure, which presents as an alternative to stenting and dilatation in the management of post-sleeve gastrectomy gastric twist.