Gastropexy

Gastropexy is an abdominal surgery in which the stomach is attached to the wall of the abdomen with stitches.

Your abdomen and lungs are separated by a thin muscular wall called the diaphragm. The oesophagus (food pipe) passes through the hiatus, a small opening in the diaphragm, into the stomach. In normal individuals, the entire stomach is located below the diaphragm. However, if the tissues within or around the hiatus weaken, the stomach bulges into the chest through the hiatal opening in the diaphragm, resulting in a condition called hiatal hernia. This condition causes digestive juices in the stomach to back up in the oesophagus and causes symptoms similar to those seen with gastroesophageal reflux disease.

In people with large hiatal hernia, gastropexy is recommended to bring back the stomach into the abdomen. The stomach is then stitched to the abdominal wall to keep it from moving again. This surgery is also performed in individuals with gastric volvulus, a condition that causes a part or all of the stomach to rotate more than 180° and result in bowel obstruction.

Surgeons recommend gastropexy in the following conditions:

• Large hiatal hernia: The condition may cause the following symptoms:
  • Bloating
  • Heartburn
  • Belching
  • Chest pain
  • Sour taste in the back of the throat
  • Pain or discomfort in the oesophagus or stomach
• Gastric volvulus (long-term and recurrent): Some symptoms of gastric volvulus include:
  • Abdominal pain
  • Vomiting
  • Dry heaving (an urge to vomit but no actual vomiting)

The surgery is conducted using general anaesthesia (a sleep-inducing medicine), so it will be performed with caution after evaluating the following:

• Heart, kidney, and lung function
• Any other conditions that you may have
• Smoking status
• Pregnancy status

You will need to visit the hospital prior to the surgery for a preoperative assessment wherein the surgeon will study your medical history and conduct various medical and imaging tests such as:

• Blood tests
• Pregnancy test
• Urine tests
• Barium swallow test (a type of X-ray used to see problems in the stomach and oesophagus)
• Endoscopy (to see the inside of the upper gastrointestinal tract using a long, flexible tube called an endoscope)
• Gastric-emptying studies (to examine the passage of food from the stomach)

In addition, you will be given certain instructions to prepare for the surgery. These include:

• Share a list of all the medications that you take, including vitamins, supplements, and over-the-counter medicines.
• You will be asked to discontinue blood thinners like aspirin, warfarin, or ibuprofen a week prior to the surgery.
• Inform the healthcare provider if you are pregnant, have allergies or other health conditions. 
• If you have a habit of smoking, the doctor will ask you to stop it.
• You will need to shower and remove all body piercings, nail polish, and make-up before arriving at the hospital on the day of the surgery.
• Arrange for a family member, friend, or responsible adult to drive you home after discharge from the hospital.
• Inform the surgeon if you experience a cold, flu, or fever on the days leading to the surgery.
• You will need to fast from midnight of the night prior to the surgery. This is done to keep your stomach empty during the surgery and avoid vomiting, one of the side effects of anaesthesia.
• Your doctor will discuss with you the procedure and risks of the surgery. If you agree to the surgery, you will be asked to sign a consent form.

After arriving at the hospital on the scheduled day of the surgery, the hospital staff will provide you with a hospital gown. A drip will be connected to your arm to supply essential fluids and medicines during the operation. The surgery is performed by the laparoscopic method in people who are undergoing gastropexy for the first time.

Laparoscopic surgery involves the following:

• You will be asked to lie on a medical table with your torso and face facing up. Either your legs or face will be kept in an elevated position.
• An anaesthetist will give you general anaesthesia to make you fall asleep.
• A tube will be inserted into your airway through your nose or mouth to help you breathe during the surgery.
• The GI surgeon will make tiny incisions (cuts) on your abdomen.
• Thereafter, he/she will inflate your abdomen with gas and insert plastic or metal tubes into the incisions to create ports so that your stomach can be stitched to these port sites.
• The surgeon will gently place your stomach into your abdomen.
• He/she will insert a needle attached to a thread through one of the ports, keeping the free end of the thread outside your abdomen. The surgeon may use a curved clamp through the port into your stomach to guide the needle.
• Then, he/she will insert the needle through the seromuscular layer of your upper stomach at a point that will keep your stomach in place and allow pulling up of your stomach to the port when the suture is tied. The surgeon will bring out the other end of the thread through the port so that both ends of the thread are outside your abdomen.
• He/she will repeat the above action by passing the needle through another port site. 
• The surgeon will remove the tubes, and deflate your abdomen.
• Using the threads that are outside the port, he/she will pull the upper part of your stomach upwards and stitch it to your abdominal wall.
• Once that is done, the surgeon will close the incisions.

The surgery lasts for about 60 to 90 minutes. 

Gastropexy may also be performed by using an open technique wherein a large cut is made on the abdomen. Compared to open surgery, the laparoscopic procedure is associated with lesser postoperative pain and faster recovery. When you regain consciousness after the surgery, you may feel tired, groggy, or restless and have a sore throat or dry mouth. These side effects of general anaesthesia usually fade within a few hours. Most individuals who undergo laparoscopic surgery are discharged after staying a night at the hospital.

Once you reach home, you will need the following care:

• You will be prescribed medications to provide relief from post-operative pain. In addition, the surgeon may also prescribe laxatives (stool softeners) and antibiotics. Take all the medicines as directed.
• Avoid wearing tight clothes around the operated area. You should also avoid rubbing the incision, swimming, taking tub baths, or using hot tubs.
• Avoid lifting objects that weigh over 4.5 kilograms for about six weeks.
• Try to walk as much as recommended by the surgeon.
• The hospital staff will teach you specific breathing or coughing exercises before you are discharged from the hospital. Practice them as recommended.
• You will be able to resume work two to three weeks after the procedure.
• You can drive seven to 10 days after surgery or as advised by the surgeon.

When to see the doctor?

Contact the surgeon immediately if you experience any of the following after the surgery:

• Fever with a body temperature over 101^°F (38^°C)
• Difficulty breathing
• Chest pain
• Nausea
• Vomiting
• Bleeding or foul-smelling discharge from the incisions
• Increased swelling or pain around the operated area
• Blood in urine or stools
• Inability to empty the bladder (stores urine)
• Diarrhoea, inability to pass gas, or constipation for more than three days
• Incisions break apart

The surgery carries the following risks and complications:

• Infection
• Bleeding from the incision site
• Blood clot formation in legs
• Increased flatulence (gas)
• Damage to the stomach, oesophagus, or lungs
• Difficulty swallowing
• Need for open surgery
• Risks of general anaesthesia such as confusion, heart attack, stroke, and lung infection

You will have a follow-up appointment in one to two weeks after the surgery.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.