Acute Gastric Volvulus: When is the Optimal Time for Repair?

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Limited literature exists regarding optimal timing for non-emergent repair of obstructing or resolved gastric volvulus. This study evaluates our institution's outcomes of early outpatient repair versus urgent or delayed inpatient repair.

A single institution retrospective review was conducted from November 2017 - August 2021 of patients who underwent repair of a resolved obstructing gastric volvulus in the early outpatient setting versus index hospitalization (urgent vs delayed). Primary outcome was overall morbidity using Clavien-Dindo classification. Secondary outcomes including length of stay, ICU admission, pneumonia, unplanned intubation, return to OR, transfusion requirement, sepsis, time to surgery, length of surgery, leak or perforation, re-volvulus while waiting for outpatient repair, and 30-day readmission rates. Categorical outcomes were evaluated using Fishers Exact test and numeric outcomes were analyzed using the Wilcoxon Rank Sum.

Eighty-one patients were included (65.4% female, mean age 77.4±10.1 yrs). Twenty-seven patients (33.3%) underwent outpatient repair, 41 (50.6%) urgent inpatient repair, and 13 (16.1%) delayed inpatient repair. Outpatient repair had shorter operative time (median 114 min vs 139 min urgent vs 144 min delayed, p=0.0003). Crural closure (outpatient 96.3% vs urgent 82.9% vs delayed 61.5%, p=0.019) and fundoplication (outpatient 81.5% vs urgent 48.8% vs delayed 53.9%, p=0.023) were performed more outpatient. 29.6% of outpatient group re-volvulized (median to volvulus 42.5 days [IQR 24-56] from presentation) vs 2.4% urgent and 0% delayed inpatient (p=0.002). Postoperative complications (ileus, urinary retention, delirium) were less common in the outpatient group (22.2% vs 55.0% urgent vs 41.7% delayed, p=0.028). Delayed inpatient had more Grade 1 complications (69% vs 32% urgent vs 7% outpatient, p=0.0003), while urgent had more Grade 4a complications (20% vs 0% both groups, p=0.0134). Analysis of mesh use pending.

Surgical success varies significantly between outpatient and inpatient repair of obstructing or resolved gastric volvulus. While outpatient has a significant increase in re-volvulus compared to inpatient that can be attributed to the extended time prior to repair, outpatient repair has a significant decrease in complications post-operatively compared to inpatient. Based on our findings, the optimal time for repair would be early outpatient repair within 2-3 weeks to prevent re-volvulus followed by delayed inpatient repair if outpatient repair cannot be achieved.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2022

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