We describe the combined use of laparoscopic and endoscopic techniques in a case of acute primary
gastric volvulus. Once the diagnosis is confirmed with a water-soluble upper gastrointestinal series, prompt intervention is required. With an atraumatic bowel grasper the stomach is re-oriented with the greater curvature in its normal anatomic position. Two transabdominal wall
sutures are placed along the greater curvature to fix it to anterior abdominal wall. Upper endoscopy is then performed. Once confident that the gastric mucosa is viable, a 20F "pull-type"
gastrostomy tube is placed endoscopically, guided by the external illumination and probing by the
laparoscope. The
gastrostomy tube now acts as an anterior anchor for the stomach allowing repositioning of the
gastropexy sutures if necessary. Endoscopy confirms the placement of a broad, properly aligned
gastropexy. Classically,
gastric volvulus has been treated by
laparotomy. Both endoscopic and laparoscopic techniques have been individually reported in the treatment of acute and chronic
gastric volvulus, however, each has as its limitations. By combining the procedures we were able to better assess both the intra-abdominal and the intraluminal status of the stomach and its position before, during, and after fixation to the anterior abdominal wall. The postoperative stay seen with the combined technique was less than has been reported in patients treated by open surgery or by either the endoscopic or laparoscopic methods alone. The combined laparoscopic and endoscopic approach to acute
gastric volvulus provides the benefit of a minimally invasive approach, to a better anterior
gastropexy. This procedure should be considered when confronted with patients with acute primary,
gastric volvulus.