Post written by Sanjhai L. Ramdeen, MD, from the Department of Minimally Invasive Surgery, and GIE Senior Associate Editor David L. Diehl, MD, FASGE, from the Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA.

Our recent VideoGIE publication describes a minimally invasive technique for treating gastric volvulus that involved teamwork between the gastroenterology and minimally invasive surgery teams. 

Gastric volvulus is the pathologic torsion of the stomach resulting in a closed-loop obstruction. It is rare but can have serious consequences including gastric ischemia, perforation, septic shock, and even death. There are 2 main types of gastric volvuli: organoaxial, with rotation of the stomach along its longitudinal axis, and mesoaxial (also known as mesenteroaxial), with rotation along its transverse axis.

Laparoscopic gastropexy or PEG are common options for treatment of gastric volvulus, but we pushed the envelope further with an even-less-invasive option: endoscopic-guided gastropexy. This technique captures the power of multidisciplinary collaboration and the use of new instruments in novel ways. We used a specialized suture-grasper device to suture the greater curvature of the stomach to the anterior abdominal wall.

Under endoscopic guidance, the suture grasper was used to introduce the suture transfascially into the gastric lumen and then was reinserted to pull the suture through the fascia and to allow it to be tied extracorporeally, thereby pexying the stomach to the anterior abdominal wall. Two rows of sutures could be placed in this manner. The patient did well postoperatively and remains well after >5 years of follow-up.

Collaboration between surgeons and gastroenterologists can be gratifying and can advance medicine synergistically across fields. This video is an outstanding demonstration of this type of fruitful cross-pollination between GI and surgery.

Organoaxial gastric volvulus.

Read the full article online.

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