Options in the treatment of totally intrathoracic stomach with volvulus

Gastric volvulus is a rare life-threatening condition resulting from rotation of the stomach by 180 degrees. We describe two patients with unusual chronic totally intrathoracic gastric volvulus that were treated by different laparoscopic techniques. Preoperatively, upper gastrointestinal contrast studies are diagnostic and, gastroscopy is helpful. Rapid progress in laparoscopy has shifted treatment away from traditional and complex open surgery. Reduction of the intrathoracic stomach, hernia sac excision and closure of the hiatal defect is now possible laparoscopically. Surgeon preference guides the addition of a fundoplication, gastropexy or gastrostomy to maintain gastric reduction. Advances in minimal access techniques mean a variety of options are now available, enabling the surgeon to successfully modify treatment for individual patients with intrathoracic gastric volvulus.