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Background Laparoscopic sleeve gastrectomy (LSG) has become a single-step operation for the management of severe obesity. A statistically significant number of participants who undergo this procedure experience nausea, vomiting, and reflux symptoms early after the operation. The objectives of this study were to measure the positive or negative effect of gastropexy on reducing distressing postoperative LSG-related gastrointestinal symptoms. Patients and Methods This was a comparative randomized study conducted from January 2018 to January 2021. The study was carried out in the general surgery department at Menoufia University Hospital, Menoufia Faculty of Medicine in Egypt. Two hundred participants were included randomly during this trial. The participants were divided into two groups, with 100 patients in each group. Patients in group A underwent gastropexy, and patients in group B underwent LSG without gastropexy. Results There was no significant difference between the groups in age or sex ( p  > 0.05). There was no significant difference in the length of hospital stay ( p  > 0.05). There was a significant difference between the two groups regarding nausea, vomiting, reflux symptoms, and the amount and frequency of antiemetics used ( p  < 0.001). There was also a significant difference in hospital readmissions ( p  < 0.05) and in clinic visits during the postoperative period. Conclusions Patients who underwent gastropexy showed a significant reduction in antiemetic consumption and a significantly lower incidence of postoperative nausea, vomiting, gastroesophageal reflux disease symptoms and gastric torsion than those who did not undergo gastropexy. Graphical abstract

In our practice, there is a growing need to perform gastrostomy tube placement in infants and young children with feeding difficulties. To avoid possible complications arising from pull-through method (pull-through PEG) we began to perform a one-step endoscopic gastrostomy with a gastropexy device (push GT). This study aimed to evaluate the safety of this technique in infants and young children. In our study, 60 pull-through PEG and push GT procedures were retrospectively analysed in patients between 2.83 and 8.6 kg. We analysed the adverse events in both groups. Age, sex, weight, diagnosis, early (occurring ≤ 7 days after the procedure) and late (occurring > 7 days after the procedure) complications were compared in the two groups. Median follow-up duration was 12 months. Early minor complications occurred only in the push GT group, but this was not statistically significant. There was no significant difference between the groups regarding early major complications. Late minor complications were significantly more common in the push GT group. There were no late major complications in the push GT group, which is statistically significant. In infants and young children, push GT with a gastropexy device is a safe method to perform gastrostomy even in patients unsuitable for pull-through PEG placement.

Background Prophylactic gastropexy reduces the occurrence of gastric dilatation and volvulus (GDV) in dogs, but ethical concerns exist due to its invasiveness. Research on veterinary professionals’ opinions of the procedure is lacking, with no data having been published either in the Republic of Ireland (ROI) or further afield. This study was designed to bridge this knowledge gap, by identifying current practices in the ROI and examining veterinary professionals’ views of the procedure. Methods A cross‐sectional study was conducted with 43 registered veterinary practitioners (VPs) and 45 registered veterinary nurses (RVNs) in the ROI, on their current practices and views on prophylactic gastropexy. Data was analysed using Microsoft Excel, with descriptive statistical analysis of quantitative data and qualitative data subjected to thematic analysis. Results Two themes relating to prophylactic gastropexy were identified: enabling perceptions and disabling perceptions. Enabling perceptions included reduced risk of GDV, cost‐effectiveness, improved quality of life and reduced anaesthetic risk. Disabling perceptions included anaesthetic and surgical risks, inability to prevent gastric dilation, potential gastropexy breakdown, cost and post‐operative complications. In addition, ethical concerns were raised regarding the procedure's invasiveness, its potential interference with natural selection and the fact that it could encourage the use of surgical solutions to problems created by improper breeding practices. Conclusions Due to ethical issues associated with the procedure, the decision to perform a prophylactic gastropexy relies on multiple patient factors, the procedure's invasiveness, the timing of the procedure and its impact on future health. This study failed to account for the owner's perspective, necessitating further research. Prophylactic gastropexy significantly reduces the risk of gastric dilatation and volvulus (GDV) in at‐risk canine patients. This study explores attitudes and practices of veterinary professionals in Ireland regarding the procedure. While the major benefit of the procedure is reduced GDV risk, ethical concerns such as its invasiveness and impact on natural selection must be considered. These findings highlight the need to examine individual patient factors when recommending prophylactic gastropexy rather than recommending the procedure for all dogs susceptible to GDV.

Purpose Paraoesophageal hernias (PEH) are associated with a high complication rate and often occur in elderly and fragile patients. Surgical gastropexy without fundoplication is an accepted alternative procedure; however, outcomes and functional results are rarely described. Our study aims to evaluate short-term outcomes and the long-term quality of life after gastropexy as treatment for PEH. Methods Single center cohort analysis of all consecutive patients who underwent gastropexy for PEH without fundoplication. Postoperative outcomes and functional results were retrospectively collected. Reflux symptoms developed postoperatively were reported using the validated quality of life questionnaire: GERD-Health Related Quality of Life Qestionnaire (GERD-HRQL). Results Thirty patients (median age: 72 years (65–80)) were included, 40% classified as ASA III. Main PEH symptoms were reflux (63%), abdominal/thoracic pain (47%), pyrosis (33%), anorexia (30%), and food blockage (26%). Twenty-six laparoscopies were performed (86%). Major complications (III-IVb) occurred in 9 patients (30%). Seven patients (23%) had PEH recurrence, all re-operated, performing a new gastropexy. Median follow-up was 38 (17–50) months. Twenty-two patients (75%) reported symptoms resolution with median GERD-HRQL scale of 4 (1–6). 72% (n = 21) reported operation satisfaction. GERD-HRQL was comparable between patients who were re-operated for recurrence and others: 5 (2–19) versus 3 (0–6), p = 0.100. Conclusion Gastropexy without fundoplication was performed by laparoscopy in most cases with acceptable complications rates. Two-thirds of patients reported symptoms resolution, and long-term quality-of-live associated to reflux symptoms is good. Although the rate of PEH recurrence requiring a new re-intervention remained increased (23%), it does not seem to affect long-term functional results.

Purpose As Japanese society ages, the number of surgeries performed in elderly patients with hiatal hernia (HH) is increasing. In this study, we examined the feasibility, safety, and potential effectiveness of the addition of anterior gastropexy to hiatoplasty with or without mesh repair and/or fundoplication in elderly Japanese HH patients. Methods We retrospectively evaluated 39 patients who underwent laparoscopic HH repair between 2010 and 2021. We divided them into 2 groups according to age: the “younger” group (< 75 years old, n = 21), and the “older” group (≥ 75 years old, n = 18). The patient characteristics, intraoperative data, and postoperative results were collected. Results The median ages were 68 and 82 years old in the younger and older groups, respectively, and the female ratio was similar between the groups (younger vs. older: 67% vs. 78%, p = 0.44). The older group had more type III/IV HH cases than the younger group (19% vs. 83%, p < 0.001). The operation time was longer in the older group than in the younger group, but there was no significant difference in blood loss, perioperative complications, or postoperative length of stay between the groups. The older group had significantly more cases of anterior gastropexy (0% vs. 78%, p < 0.001) and less fundoplication (100% vs. 67%, p = 0.004) than the younger group. There was no significant difference in HH recurrence between the groups (5% vs. 11%, p = 0.46). Conclusions The addition of anterior gastropexy to other procedures is feasible, safe, and potentially effective in elderly Japanese patients with HH.

PurposeThe aim of this study is to compare balloon-retention percutaneous radiologic gastrostomy (PRG) tube insertion performed with and without gastropexy, primarily focusing on pain and patient-reported outcomes.Materials and MethodsResearch ethics board approved a dual-arm, single-centre, randomized trial of 60 patients undergoing primary 14-French PRG tube insertion (NCT04107974). Patients were randomized to receive either PRG with gastropexy or without gastropexy. Data were collected for technical outcomes, patient-reported outcomes pre-procedure, post-procedure and at 1-month, as well as quality of life parameters at 1-month post-procedure (EQ5D-5L, Visual Analogue Scale and Functional Assessment of Cancer Therapy-Enteral Feeding questionnaires). Complications occurring up to 6-months post-procedure were recorded.ResultsSixty patients were randomized to the gastropexy group (n = 30) or non-gastropexy (n = 30) group. One non-gastropexy patient was withdrawn from the study due to failed insertion. PRG procedural time was significantly longer when using gastropexy (mean 11.4 ± 7.19 min) compared with non-gastropexy (mean 6.79 ± 4.63 min; p < 0.05). Pain scores did not differ between the two groups pre-procedure, post-procedure and at 1-month follow-up, nor did 1-month quality of life parameters. Six (20%) minor complications occurred in the gastropexy group and nine (31%) minor complications in the non-gastropexy group (p = 0.330). Two (6.9%) major complications occurred in the non-gastropexy group (p = 0.458).ConclusionThere is comparable patient tolerability when balloon-retention PRG insertion is performed with or without gastropexy sutures. This study also demonstrated a trend towards fewer complications when gastropexy is utilized. However, further larger trials are required to compare complications of the two approaches for PRG insertion.Level of EvidenceLevel 2, randomized trial

Background Observational studies based on quality-of-life and endoscopy relate sleeve gastrectomy (SG) to gastroesophageal reflux disease (GERD), while some functional studies have demonstrated a decrease in esophageal exposure to gastric acid after SG. Currently, it is recommended to treat hiatal hernia along with the SG. However, as the sleeve gastrectomy involves the resection of the fundus, it is not possible to add a traditional fundoplication to the closure of the hiatus. Methods Based on the classic works of Hill et al., and more recent studies by Swänstrom and Aye, our group has incorporated a modified Hill’s gastropexy to the sleeve gastrectomy for patients with pathologic GERD and/or huge hiatal hernia submitted to weight loss surgery. Results A 28-year-old male patient, 43 kg/m 2 BMI, with a small hiatal hernia and pathologic GERD was scheduled for sleeve gastrectomy. After complete fundus and left crus dissection, the phrenoesophageal membrane was opened and the distal esophagus dissected. The hiatus was closed with interrupted sutures. The sleeve was completed over a 42-French bougie. The preaortic fascia was dissected at the root of the crura and three interrupted sutures placed approximating the gastroesophageal junction to the aforementioned fascia. At 6 months from the operation, weight loss has been satisfactory and the patient does not complaint GERD. Barium swallow demonstrates absence of gastroesophageal reflux, pHmetry and manometry have normalized, and endoscopy shows no esophagitis. Conclusions Gastropexy to the preaortic fascia is a possible antireflux technique to combine with SG.

PurposeThough gastric volvulus in neonates and infants resolves by conservative therapy and aging, some cases require surgical intervention. This study aimed to review the cases of gastric volvulus requiring surgical intervention and evaluate their characteristics.MethodsWe retrospectively reviewed gastric volvulus cases requiring surgical intervention. Surgical indication was persistent acute gastric volvulus and repeated hospitalization for gastric volvulus. We evaluated the characteristics of those cases requiring surgical intervention and the surgical results of laparoscopic gastropexy.ResultsThe median age of patients included was 4 years (range: 1–6 years). All eight cases of gastric volvulus requiring sugery had congenital spleen diseases. Six of the eight cases suffered from a wandering spleen, while two cases presented with situs inversus with asplenia. Both splenopexy (preperitoneal distension balloon [PDB] or blunt separaion methods) and gastropexy were performed in cases with wandering spleen. No postoperative complications were reported in any of the eight cases, except the recurrence of gastric volvulus due to suture shedding in one case.ConclusionLaparoscopic gastropexy for gastric volvulus and splenopexy for cases concomitant with wandering spleen were found to be effective surgical approaches. Both PDB and blunt separation methods for making extraperitoneal pockets for the spleen were employed successfully.