Acute gastric volvulus related to adhesions after laparoscopic fundoplication

Laparoscopic antireflux procedures currently are considered to be as safe, cost efficient, and effective as the techniques used previously in antireflux surgery, although life-threatening complications after antireflux surgery have been reported with both open and laparoscopic fundoplication. We report the case of a 38-year-old man who presented with acute abdominal pain and vomiting 8 months after a laparoscopic Nissen-Rosetti fundoplication. The diagnosis of gastric volvulus was suspected. The endoscopic examination showed a proper location of the fundoplication and features consistent with early gastric ischemia. Rotational maneuvers failed to untwist the volvulus. Emergency surgery was performed, involving a conventional laparotomy. At surgery, the volvulus was found related to a thick adhesion between the opening of the xiphoidal cannula and the hilus hepatis. The section of the adhesion allowed immediate untwisting of the volvulus. Despite a general assumption that laparoscopic procedures will reduce the incidence of postoperative adhesion formation, it should be kept in mind that laparoscopic techniques do not preclude the deposit of unusual foreign microbodies, which is an admitted mechanism of adhesion formation.