Ainize Ibarzabal (Gastrointestinal Surgery Senior Specialist)
Ricard Corcelles (Gastrointestinal Surgery Senior Specialist)
Gabriel Díaz Del Gobbo (Gastrointestinal surgery specialist)
Victor Turrado (Gastrointestinal Surgery Specialist)
Hospital Clínic, Barcelona – Spain
A 33-year-old woman with a medical history of hypothyroidism secondary to Hashimoto thyroiditis, Arnold-Chairi syndrome with spina bifida, and neonatal hydrocephalus who underwent several surgical interventions for scoliosis repair and ventriculoperitoneal shunting, and had morbid obesity (BMI 43 Kg/m2). She underwent a laparoscopic sleeve gastrectomy with an uneventful postoperative course.
On the 14th postoperative day she arrived at the Emergency Department with a clinical history of 4 days’ solid and liquid dysphagia. On examination her vital signs were stable and there were no pathological findings in the abdominal examination.
Further investigation was carried out with a blood test that showed no alterations. The barium swallow X-ray showed a stop under the esophagogastric junction (FIG1). An endoscopy was performed showing an angulated area at the level of the gastric fundus.
Surgical treatment was performed laparoscopically. The patient was placed in the supine position and 5 trocars were used. The configuration was a 12-mm port in the supraumbilical position for a 30º scope, a 12-mm port in the left upper-quadrant, and three 5-mm ports in the epigastrium, right flank and left flank.
On examination the gastric tube was found to be twisted over the transverse axis due to an adhesion from the abdominal wall to the prepyloric region.. A 32 Fr bougie was placed and the properly oriented gastric tube was fixed with interrupted vicryl stitches from the new major curvature to the major omentum. An intraoperative endoscopy was performed to verify the uneventful passage of the endoscope through the gastric tube.
Total operative time was 3 hours. The patient had an uneventful postoperative evolution and was discharged on the 6th postoperative day. The patient had no further complaints during follow-up.