Aim: To assess the long term objective anatomic and symptomatic outcomes after surgical repair of intrathoracic gastric volvulous.
Methods: All patients undergoing surgical repair of intrathoracic gastric volvulus by a single surgeon from January 2004 thru December 2006 at Creighton University were included. Prospectively collected data was retrospectively reviewed. Patients underwent one year phone questionnaire follow-up. Gastroesophageal reflux disease related symptoms, chest pain and satisfaction with surgery were assessed. In addition, objective evaluation for hiatal hernia recurrence was undertaken either by upright esophagram or upper endoscopy. Any symptomatic or asymptomatic recurrence was considered a failure. Patients with less than one year follow-up were excluded.
Results: Forty-two patients underwent surgical repair of intrathoracic gastric volvulus during the study period. Twenty two patients had more than one year follow-up. Mean follow-up is 21.7 (range 12 to 34) months. Twelve (54.5%) were women. The mean age was 70.4 (range52 to 86). Six patients (27.3%) underwent a trans-thoracic repair. One patient in the laparoscopic group required an open laparotomy as she was unable to tolerate the pneumo-peritoneum. Six patients (27.3%) were deemed to have short esophagus and underwent Collis gastroplasty with an anti-reflux procedure. An additional 13 patients had a concomitant anti-reflux procedure performed. The remaining three patients had only hernia reduction and a hiatal closure. One year f/u was available in 95.5% of patients. There were two (9.1%) anatomic failures. One was a symptomatic (primary transthoracic repair) requiring emergent surgery 11 months postoperatively and the other patient in the primary laparoscopic group had a 1-cm asymptomatic hiatal hernia. Endoscopic dilation was required in three patients (13.6%) for post-fundoplication dysphagia. All patients report a high degree of satisfaction with surgery (mean score 9.4 on scale of 1 to 10).
Conclusion: There is a high incidence of short esophagus in patients with intrathoracic gastric volvulous. The surgical repair of intrathoracic gastric volvulus is safe and durable with high patient satisfaction at long term follow-up.