A twisted gastric sleeve occurs when the gastric sleeve tube twists around its longitudinal axis by 180 degrees.
The twist involves the stomach area between the gastric antrum (lower one third of the stomach). The staple line of this part of the stomach turns counterclockwise from a lateral to medial position.
The twisted gastric sleeve lumen results in a functional obstruction leading to severe acid reflux after surgery.
Severe acid reflux causes a hiatal hernia to develop. A hiatal hernia further exacerbates acid reflux and within a year or two after initial gastric sleeve surgery, acid reflux symptoms become difficult to control with medications like Nexium and Protonix.
What Causes a Twisted Gastric Sleeve?
The cause of a twisted gastric sleeve is aggressive stomach resection resulting in the collapse of muscular scaffolding of the stomach. This kind of stomach mutilation, as I like to call it, results from three technical errors that must happen simultaneously:
- More than 50% of the antrum is resected.
- The incisura angularis (natural angulation of the stomach) is narrowed.
- A very small calibration tube is used with uneven pulling on the posterior and anterior walls of the stomach during stomach resection.
How Is It Treated?
First-Line Approach
The treatment of twisted sleeve gastrectomy aims at restoring stomach anatomy, if possible, by sequential endoscopic dilation using special dilators balloons.
A total of 4 dilations can be offered. Each dilation aims at stretching the gastric sleeve lumen to allow the lateral staple line to move clockwise back to the lateral position.
The success rate of such an approach varies depending on the degree of “mutilation” and the duration of time since initial gastric sleeve surgery. Concomitantly, a temporary stent can be placed within the lumen of the stomach to promote stretching.
Surgical Option
If this first line endoscopic approach fails to untwist the gastric sleeve, conversion to gastric bypass is the only solution left, to alleviate acid reflux.
Can It Be Prevented?
Twisted gastric sleeve is a rare complication of sleeve gastrectomy. This complication is prevented only if your bariatric surgeon understands stomach anatomy and physiology as well as sleeve gastrectomy mechanism of action.
A competent bariatric surgeon preserves the gastric antrum, avoids narrowing the incisura angularis and maintains even traction on the anterior and posterior stomach walls during stomach resection.
A properly performed gastric sleeve surgery is both safe, and reliable. Most importantly, a properly performed sleeve gastrectomy does not cause acid reflux.
Suffering from Acid Reflux After Sleeve Surgery?
If you had a sleeve gastrectomy, and you currently suffer from acid reflux disease, give us a call at 832-945-8717. We can help you.