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Background <p>Limited literature exists regarding timing for non-emergent repair of obstructed or resolved gastric volvulus. This study evaluates our institution’s outcomes of outpatient versus urgent or delayed inpatient repair.</p> Methods <p>A single institution retrospective review was conducted from November 2017 to August 2025 of patients who underwent repair of resolved obstructing gastric volvulus in the outpatient setting versus index hospitalization (urgent vs delayed). Primary outcome was morbidity using Clavien–Dindo classification. Secondary outcomes include length of stay, ICU admission, pneumonia, unplanned intubation, return to OR, transfusion, sepsis, time to surgery, length of surgery, leak, re-volvulus before repair, and 30-day readmission rates. Categorical and numeric outcomes were evaluated using Fishers Exact test and Wilcoxon Rank Sum respectively.</p> Results <p>Eighty-one patients were included (65.4% female, mean age 77.4 ± 10.1 years). 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 times (median 114 vs 139 min urgent vs 144 min delayed, <i>p</i> = 0.0003), cruroplasty (outpatient 96.3% vs urgent 82.9% vs delayed inpatient 61.5%, <i>p</i> = 0.019) and fundoplications performed (outpatient 81.5% vs urgent 48.8% vs delayed inpatient 53.9%, <i>p</i> = 0.023). Re-volvulus before repair occurred in 29.6% of the outpatient group (median to volvulus 42.5 days [IQR 24–56] from presentation) versus 2.4% urgent and 0% delayed inpatient group (<i>p</i> = 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, <i>p</i> = 0.028). The delayed inpatient group had more Grade 1 complications (69 vs 32% urgent vs 7% outpatient, <i>p</i> = 0.0003), while the urgent group had more Grade 4a complications (20 vs 0% both other groups, <i>p</i> = 0.0134). There was no significant difference in mesh application.</p> Conclusion <p>Based on our findings, the optimal operative time is the outpatient setting within 2–3 weeks to prevent re-volvulus followed by delayed inpatient repair when appropriate.</p>

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Acute gastric volvulus: optimal timing for repair?

  • 期刊论文

  • 发表日期：

    2026年7月22日

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  • Erika Michelin,
  • Lauren Eberhardt,
  • Giuseppe Zambito,
  • David Scheeres,
  • Amy Banks-Venegoni

摘要

Background

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

Methods

A single institution retrospective review was conducted from November 2017 to August 2025 of patients who underwent repair of resolved obstructing gastric volvulus in the outpatient setting versus index hospitalization (urgent vs delayed). Primary outcome was morbidity using Clavien–Dindo classification. Secondary outcomes include length of stay, ICU admission, pneumonia, unplanned intubation, return to OR, transfusion, sepsis, time to surgery, length of surgery, leak, re-volvulus before repair, and 30-day readmission rates. Categorical and numeric outcomes were evaluated using Fishers Exact test and Wilcoxon Rank Sum respectively.

Results

Eighty-one patients were included (65.4% female, mean age 77.4 ± 10.1 years). 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 times (median 114 vs 139 min urgent vs 144 min delayed, p = 0.0003), cruroplasty (outpatient 96.3% vs urgent 82.9% vs delayed inpatient 61.5%, p = 0.019) and fundoplications performed (outpatient 81.5% vs urgent 48.8% vs delayed inpatient 53.9%, p = 0.023). Re-volvulus before repair occurred in 29.6% of the outpatient group (median to volvulus 42.5 days [IQR 24–56] from presentation) versus 2.4% urgent and 0% delayed inpatient group (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). The delayed inpatient group had more Grade 1 complications (69 vs 32% urgent vs 7% outpatient, p = 0.0003), while the urgent group had more Grade 4a complications (20 vs 0% both other groups, p = 0.0134). There was no significant difference in mesh application.

Conclusion

Based on our findings, the optimal operative time is the outpatient setting within 2–3 weeks to prevent re-volvulus followed by delayed inpatient repair when appropriate.