Gastropexy for Gastric Volvulus: What Patients Need to Know

Introduction and Terminology of the Procedure

Gastropexy is a surgical procedure often used in the treatment of a medical condition known as gastric volvulus. Gastric volvulus is a rare but serious condition where the stomach twists on itself, causing severe abdominal pain and potentially leading to dangerous complications, including stomach perforation and strangulation. The term “Gastropexy” refers to the surgical fixation of the stomach to the abdominal wall or nearby organs to prevent this twisting.

The United States sees an estimated few thousand cases of gastric volvulus annually, a significant proportion of which are treated with gastropexy. This surgical intervention has shown high effectiveness in preventing recurrence and alleviating symptoms associated with gastric volvulus.

Indications for Gastropexy

Gastropexy is primarily indicated for the treatment of gastric volvulus. However, the specific circumstances under which this procedure is recommended can vary. Here are several common indications:

• Acute Gastric Volvulus: This is a medical emergency and requires immediate intervention. Gastropexy is often performed after initial detorsion (untwisting) of the stomach to prevent a recurrence.
• Chronic or Recurrent Gastric Volvulus: In patients who experience repeated episodes or persistent symptoms, gastropexy is performed to provide long-term relief.
• High Risk for Gastric Volvulus: Certain anatomical variations or other medical conditions can increase the risk of developing gastric volvulus. In these cases, gastropexy may be recommended as a preventive measure.
• Failed Non-Surgical Management: If symptoms persist despite non-surgical interventions such as medication, diet modification, or endoscopic detorsion, gastropexy may be considered.

Patients need to discuss their specific situation with their healthcare provider to determine if gastropexy is the most appropriate treatment option for them.

Pre-Op Preparation

Preparation for a gastropexy procedure involves several important steps:

• Fasting: Patients are usually required to fast (no food or drink) for a certain number of hours before the surgery.
• Medication Adjustments: Some medications may need to be paused or adjusted before surgery. This includes over-the-counter medications, prescription drugs, and supplements.
• Pre-Op Labs and Imaging: Certain lab tests or imaging studies may be ordered to assess the patient’s overall health and readiness for surgery.
• Pre-clearance Authorization: Some insurance companies require pre-authorization for certain surgical procedures. Check with your insurance company to avoid unexpected expenses.
• Transportation: As the procedure requires anesthesia, patients will need to arrange for someone to drive them home afterward.
• Work or School Notes: Patients may need to provide documentation to their school or employer regarding their upcoming surgery and expected recovery period.

Remember, individual circumstances may warrant different approaches, so it is crucial to consult with your healthcare provider for precise pre-operative instructions. Our telemedicine primary care practice is equipped to provide pre-operative clearances and ordering of pre-op labs and imaging.

Procedure Technique for Gastropexy

Understanding the gastropexy procedure can provide comfort and clarity as you prepare for your operation. This step-by-step guide is intended to simplify the medical jargon, giving you a clear picture of what the doctor will be doing during the procedure.

Step 1: Anesthesia

The procedure begins with the administration of general anesthesia to ensure that you feel no discomfort during the surgery. A tube may be inserted into your throat to assist with breathing.

Step 2: Incision and Access

Typically, gastropexy is performed using a minimally invasive technique called laparoscopy. Small incisions are made in the abdomen, through which a laparoscope (a thin tube with a light and camera) and other surgical instruments are inserted.

Step 3: Examination and Detorsion

The surgeon examines the abdomen to assess the state of the stomach and other organs. If the stomach is twisted (volvulus), the surgeon will carefully untwist it.

Step 4: Gastropexy

In the actual gastropexy step, the surgeon secures the stomach to the abdominal wall or adjacent organs using sutures or staples. This prevents the stomach from twisting again in the future.

Step 5: Examination Post Gastropexy

After the stomach is secured, the surgeon checks the stomach and the surrounding areas again to ensure the gastropexy is successful and that there are no complications.

Step 6: Closure

Finally, the laparoscope and other instruments are removed, and the incisions are closed with sutures or staples. A dressing is applied to the incision sites to protect them as they heal.

This step-by-step guide gives a broad overview of the gastropexy procedure. Remember, each patient and situation is unique, and the procedure may be slightly different based on your individual needs. Always talk to your doctor to understand exactly what to expect from your specific procedure.

Duration of Gastropexy

The gastropexy procedure generally lasts between 1 to 3 hours. The exact duration can vary depending on the complexity of the case and the patient’s overall health condition.

Post-Op Recovery from Gastropexy

After gastropexy, most patients are required to stay in the hospital for 1 to 2 days for close monitoring. Regular follow-ups with the surgeon will be scheduled for the weeks following the procedure to assess healing and recovery progress.

Rehabilitation or physical therapy is typically not necessary. However, you may need to make temporary lifestyle changes, such as adjusting your diet and limiting strenuous physical activity, as your body recovers. Most patients can return to work within 1 to 3 weeks, but the exact duration will depend on the nature of their job and individual recovery pace.

Complete recovery typically takes a few weeks, but some patients may continue to experience minor symptoms like bloating and indigestion for several months.

Remember, our practice offers same-day visits up until 9 pm on weekdays and 5 pm on weekends if you need work or school notes or have any concerns about your recovery.

Effectiveness of Gastropexy

Gastropexy is highly effective in treating gastric volvulus, with success rates reported to be over 90% in many studies. The procedure is particularly effective at preventing recurrence of the condition, with recurrence rates dropping to below 5% after the procedure.

However, the effectiveness of gastropexy can be influenced by a variety of factors. Patients with good overall health, and those without complex medical histories or complications, generally have better outcomes. Additionally, patients who follow recommended post-op care instructions and lifestyle changes typically see improved results.

Conversely, the effectiveness of gastropexy may be lower in certain situations. These include patients with multiple health conditions, advanced age, or those who have had previous abdominal surgeries. Furthermore, the presence of complications such as severe inflammation, stomach perforation, or gangrene can lower the effectiveness of the procedure and increase the risk of postoperative complications.

It’s important to discuss your case with your doctor to get a better understanding of the expected effectiveness of the procedure in your specific situation.

Adverse Events with Gastropexy

While gastropexy is generally safe, as with any surgical procedure, there are potential risks and adverse events. These include:

• Bleeding (2-5%): Post-operative bleeding can occur if a blood vessel is injured during the procedure. This is usually managed with medications or additional surgical interventions.
• Infection (1-3%): Infections can develop at the surgical site or within the abdomen, and are usually treated with antibiotics.
• Recurrence of gastric volvulus (less than 5%): While gastropexy is generally effective at preventing recurrence, it can occur in rare cases.
• Adverse reactions to anesthesia (rare): These reactions can range from mild nausea to severe allergic reactions.

The mortality rate from gastropexy is less than 1%, making it a relatively safe procedure.

Alternatives to Gastropexy

While gastropexy is a common treatment for gastric volvulus, there are alternatives. Non-surgical interventions, such as endoscopic reduction, can sometimes resolve the issue, particularly in cases of chronic or recurrent gastric volvulus. Medications to decrease stomach acid and dietary changes may also help manage symptoms. For those not suited for surgery, a procedure called percutaneous endoscopic gastrostomy (PEG) can be performed to prevent recurrence. It’s important to discuss these alternatives with your healthcare provider to determine the best treatment option for your specific situation.

Experimental or Emerging Technologies

Research is ongoing for new treatments for gastric volvulus. One promising area is the development of minimally invasive laparoscopic techniques. These procedures, which use small incisions and specialized instruments, may lead to less post-operative pain, fewer complications, and quicker recovery. However, these techniques are still being refined and are not widely available at this time.

Conclusion

Understanding the gastropexy procedure, its potential risks, recovery expectations, and alternatives can help patients make informed decisions about their gastric volvulus treatment. Despite the potential for adverse events, gastropexy remains a safe and effective procedure for most patients. With ongoing advancements in technology, the future of gastric volvulus treatment holds promise.

Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.