Reyes-Zamorano Jesús
Cirugía del aparato digestivo y laparoscopia, México DF, Mexico.
Cir Cir. 2014 Sep-Oct;82(5):541-50.
Gastric volvulus can be classified according to etiology as primary or secondary, according to anatomy as or mesenteroaxial, and according to onset as acute or chronic. Management of secondary gastric volvulus acute should always be surgery and the choice of surgical procedure for treatment is chosen according to etiology. Adherolysis and extraction of foreign bodies (suture, mesh, and gastric band) are important in those cases associated with previous abdominal surgery. Nissen fundoplication is a safe and effective procedure. Severe late complications of laparoscopic Nissen fundoplication are extremely rare occurrences. Among the reported complications is gastric volvulus.
Presentation of two cases and review of literature.
Two cases of acute gastric volvulus secondary to laparoscopic Nissen fundoplication presenting with epigastric pain and nonproductive retching and treated by laparoscopy are described. Symptoms upon presentation, incidence, diagnosis, treatment and predisposing factors to gastric volvulus postfundoplication are discussed.
Gastric volvulus rarely occurs as a complication of Nissen fundoplication with an incidence similar to others of late complications. The described mechanisms that originate gastric volvulus postfundoplication are related to adhesions, foreign bodies as suture (polyester), gastrostomy tubes and mesh, gastropexy and internal gastric herniation through a "transfundoplication" window. A high index of suspicion is required in those patients presenting with acute symptoms of gastric obstruction in the first year following laparoscopic Nissen fundoplication. Laparoscopic approach is safe with or without gastropexy, always correcting the underlying mechanisms that cause gastric volvulus.
胃扭转可根据病因分为原发性或继发性，根据解剖结构分为器官轴型或系膜轴型，根据起病情况分为急性或慢性。继发性急性胃扭转的治疗通常应采取手术，手术方式的选择需根据病因确定。对于既往有腹部手术史的病例，粘连松解和异物（缝线、补片和胃束带）取出很重要。nissen胃底折叠术是一种安全有效的手术。腹腔镜nissen胃底折叠术的严重晚期并发症极为罕见。已报道的并发症中有胃扭转。
介绍两例病例并复习文献。
描述了两例因腹腔镜nissen胃底折叠术继发急性胃扭转的病例，患者表现为上腹部疼痛和干呕，通过腹腔镜进行治疗。讨论了发病时的症状、发病率、诊断、治疗以及胃底折叠术后胃扭转的诱发因素。
胃扭转作为nissen胃底折叠术的并发症很少见，其发病率与其他晚期并发症相似。已描述的胃底折叠术后引发胃扭转的机制与粘连、异物（如聚酯缝线）、胃造瘘管和补片、胃固定术以及通过“经胃底折叠术”窗口形成的胃内疝有关。对于在腹腔镜nissen胃底折叠术后第一年出现急性胃梗阻症状的患者，需要高度怀疑。无论是否进行胃固定术，腹腔镜手术都是安全的，总能纠正导致胃扭转的潜在机制。
