A combined laparoscopic and endoscopic approach to acute gastric volvulus associated with traumatic diaphragmatic hernia

PURPOSE: The purpose of the article was to describe a comprehensive approach to laparoscopic repair of acute intrathoracic gastric volvulus in acquired diaphragmatic hernia. BACKGROUND: Traumatic diaphragmatic hernias are observed in 10% of diaphragmatic injuries, which include blunt trauma, penetrating trauma, and iatrogenic injuries. It is of utmost importance because of its high morbidity and mortality. Minimally invasive approaches are considered to be safe and effective procedures. They also provide rapid recovery from the operation, avoid the morbidity of laparotomy, and allow rapid recovery of gastric function. METHOD: From June 2002 to June 2006, we encountered 4 cases of acquired diaphragmatic hernia with acute gastric volvulus, which were successfully treated with laparoscopic reduction, detorsion, repair of diaphragmatic hernial defect, and percutaneous endoscopic gastropexy. RESULTS: There were no operative complications. All 4 patients tolerated the procedure well and the patients were discharged 1 to 3 days after the operation. After 1 to 2 years of follow-up, there were no radiologic recurrences of the volvulus and all patients remained asymptomatic. CONCLUSIONS: Laparoscopic surgery represents a safe and acceptable approach in the treatment of acute gastric volvulus through the abdominal approach with minimal morbidity and good outcome.