Management of Twisted Stomach after Laparoscopic Sleeve Gastrectomy
Authors: Ibrahim Ahmed M , Moneim Ayman H Abdel , Ahmed Ahmed G 
Published: November 2024

Abstract

Background
Obesity prevalence has increased worldwide in the past 50 years, reaching pandemic levels. Obesity represents a major health challenge because it substantially increases the risk of diseases such as type 2 diabetes mellitus, fatty liver disease, hypertension, myocardial infarction, stroke, dementia, osteoarthritis, obstructive sleep apnea and several cancers, thereby contributing to a decline in both quality of life and life expectancy. Treatment of obesity is a worldwide concern, laparoscopic sleeve gastrectomy considered one of the most used surgical treatment, despite its technical eases and simplicity it’s not free from complication and one of it is gastric twist.

Aim of the Study
to determine the incidence, etiology and recent modalities in the management of twisted stomach after sleeve gastrectomy, either laparoscopic or endoscopic solutions according to different presentations of patients.

Results
The time interval between the primary operation and the onset of symptoms considered a very important factor as it shown from the study, the less time interval suggests successful endoscopic treatment with p-value 0.030 for the patient whom presented from one weak to one month, and also suggests to laparoscopic conversion surgery with p-value 0.036 for the patients whom presented from 6 months up to more than one year. The patient state, stability and place of presentation also considered an important factor as it had been shown from the study that shows a statistically significant increase frequency of ER in Laparoscopic adhesiolysis and/or gastropexy group was (70%), followed by Laparoscopic conversion surgery group was (50%), and the lowest frequency in endoscopic group was (16.7%); as for the clinic presentation there was increased frequency of clinic in endoscopic group was (83.3%); followed by Conversion surgery group was (50%), and the lowest frequency in Laparoscopic group was (30%), with (x2= 8.038 and p-value 0.018). Also the degree of twist is one of most important factor that suggest the proper management option, the present study shows a statistically significant increase frequency of 1st degree of twist in Endoscopic group and Laparoscopic adhesiolysis and/or gastropexy group, with p-value (p = 0.041); as for the 3rd degree of twist there was higher frequency in Laparoscopic conversion surgery, with p-value (p = 0.024).

Patients and Methods
A cohort study included 30 patients admitted at Ain Shams University Hospitals with a diagnosis of gastric twist post laparoscopic sleeve gastrectomy and, all patients in the study were admitted for clinical and radiological assessment then followed by either laparoscopic and/or endoscopic intervention as soon as possible according to different results of clinical, radiological and endoscopic assessment.

Conclusion
Twisting of stomach is a rare complication post laparoscopic sleeve gastrectomy, and it considered an emergency condition should be treated as soon as possible, there are different options of management varies from endoscopic solutions either by balloon dilatation and/or gastric mega stent insertion up to laparoscopic intervention either by laparoscopic adhesiolysis and/or gastropexy or by conversion surgery according to several factors as time interval between the primary laparoscopic sleeve, the patient state and stability during presentation and also the site, type and degree of twist.