Editing Gastric volvulus (section)

== '''Definitive treatment''' ==

* Goals - return stomach to     anatomic position, repair associated abnormalities, and prevent recurrence     (otherwise occurs in 64% of patients treated conservatively)
* In unstable patients, open     approach is recommended
* OT can be done electively in     patients that improve well or achieve detorsion with low risk of     strangulation
* '''Technique'''
** Abdominal approach with      upper midline laparotomy (can sometimes be done laparoscopically)
** Decompression, detorsion,      and observation for ischaemia
*** Any strangulated segments       need to be resected
**** Close the stomach if you        can
**** If patient is unstable and        large gastric resection is required, drain the distal oesophagus, close        the duodenal stump and place a feeding jejunostomy. Roux-en-Y        jejuno-oesophagostomy will subsequently be needed.
*** If unable to reduce:
**** Guide NGT into place
**** Consider aspirating        contents of stomach via needle or gastrotomy
**** Thoracotomy
** If the '''patient is      stable''', fix any      diaphragmatic defect and do a proper 'elective' repair
*** Excise hernia sac
*** Suture the crura
*** If a paraoesophageal hernia       was present, consider a fundoplication
** If the '''patient is      unstable''', just      do a suture gastropexy to anterior abdominal wall and complete the      operation
* Stable patients with high     surgical risk could have PEG gastropexy (two tube gastrostomies will fix     the stomach better than one) but this is uncommonly done
** This could also be done for      a spontaneous volvulus


[[Category:UGIS]]