A case report of gastric torsion treated by laparoscopic gastric fixation With the wide development of gastroenterography and gastroscopy, the number of gastric torsion cases found has gradually increased, which has attracted increasing clinical attention. Gastric torsion can be categorized into acute and chronic gastric torsion according to the course of the disease and clinical manifestations, and the treatment can be categorized into non-surgical treatment and surgical treatment. When gastric torsion has clinical symptoms or dysfunction, and when repeated non-surgical treatment of gastric torsion is ineffective, surgical treatment is needed. There are two types of surgical treatment: open and laparoscopic. We now report one case of chronic gastric torsion in an adult treated by laparoscopic surgery in our department. Clinical data 1.General data: the patient is a 39-year-old female, height 161cm, weight 74kg. 2 years of medical history, the main symptoms are epigastric discomfort, fullness, belching, poor appetite, aggravated after eating, oral gastric drugs can be relieved, the symptoms recurring. Symptoms worsened in the month before admission, and upper gastrointestinal imaging showed that the greater curvature of the stomach was turned upward and protruded in an arc, and the concave surface of the lesser curvature of the stomach was downward, which was diagnosed as acute gastric torsion, and gastric torsion restoration was performed under gastroscopy. After gastroscopic repositioning, the symptoms were alleviated, but the upper gastrointestinal imaging still showed gastric torsion. Gastroscopy showed chronic superficial gastritis. Upper gastrointestinal imaging and gastroscopy revealed organ-axial gastric torsion without any abnormalities such as septal hernia, gastrointestinal tumor, esophageal hiatal hernia, or giant gastric ulcer. 2. Surgical method:Under general anesthesia, the patient was placed in the supine position with the head high and feet low at 30°. A longitudinal incision of 1cm was made at the upper edge of the umbilicus, a pneumoperitoneum needle was inserted, a CO2 pneumoperitoneum was established, and laparoscopic exploration was inserted to clarify the diagnosis. The stomach was found to be rotated along the longitudinal axis by about 120°, the perigastric ligament was loose, the greater and lesser curvature of the mesentery were loose, and the diaphragm did not show any abnormality. The stomach was repositioned and then folded and closed with 3 non-absorbable sutures on the lesser curvature side to tighten the hepatogastric ligament on the lesser curvature side. Then, at the angle of Hills and the fundus of the stomach, 5 sutures were made between the greater curvature of the gastric body and the left hepatic deltoid ligament, the left side of the abdomen and the left anterior abdominal wall of the mural peritoneum, and the pneumoperitoneum pressure was lowered to 10 mmHg, and fixed with a knot under the microscope. The operation time was 70 minutes, and the bleeding was less than 10 ml. Results The patient was put on a liquid diet on the second day of the operation, and then on the fourth day of the operation, the patient was gradually put on a normal diet. The symptoms of epigastric discomfort, abdominal distension and belching disappeared, and the upper gastrointestinal imaging showed a normal gastric position on the 5th day after the operation, and the patient was discharged from the hospital on the 7th day. He was discharged on the 7th day. He was followed up for 5 months without recurrence. Discussion Abnormal rotation of the stomach, resulting in morphological changes (e.g., the greater curvature is upward, the lesser curvature is downward, the pylorus is rotated to the left side of the spine, etc.), is called gastric torsion. From the anatomical point of view, it can be divided into organ-axial type, pyloric-axial type and mixed type. The organ-axis type of torsion is along the longitudinal axis of cardia and pylorus, and the meconium-axis type of gastric torsion rotates from right to left or left to right on the axis between the greater and lesser omentum (i.e., the line connecting the midpoints of the greater and lesser curvatures of the stomach), and the mixed type has the characteristics of the two types mentioned above. According to the extent of torsion and the angle of torsion, there are two types of torsion: complete torsion (torsion of 180° or more) and incomplete torsion (torsion of less than 180°). Primary gastric torsion is uncommon, occurring as a primary event in only 30% of cases, and is mostly secondary to paraesophageal hernia, traumatic diaphragmatic hernia, abdominal banding, or adhesions, and can lead to gastric obstruction or strangulation when the torsion exceeds 180°. Gastric torsion occurs mainly in the elderly, but also in children and young people, with a mortality rate of 30% to 50%, and the main causes of death are strangulation, necrosis, perforation, and hypovolemic shock. Laxity of perigastric ligament is the main cause of gastric torsion. Generally speaking, the combination of the causative factors such as paraesophageal hiatal hernia, diaphragmatic injury, diaphragmatic bulge, gastric ulcer, gastric tumor, phrenic nerve injury causing diaphragmatic paralysis, compression of abdominal organs and abdominal adhesions and perigastric suspensory ligament laxity will lead to gastric torsion. The highest diagnostic yield is achieved by barium meal and upper gastrointestinal endoscopy. Non-surgical treatments include manipulation and gastroscopic repositioning. However, if chronic gastric torsion still recurs after medical treatment, surgery should be performed, which can not only eliminate the symptoms, but also prevent the life-threatening consequences of strangulation in the event of an acute attack. When performing surgery for gastric torsion, the cause of gastric torsion should be carefully examined; if it is due to adhesion, then it should be separated and cut off; if it is due to gastroduodenal ulcer or tumor, then it should be performed gastrectomy and radical tumor curettage; if it is due to diaphragmatic hernia, internal hernia, or abdominal wall hernia, then it should be performed hernia repair after reset, and if it is due to laxity of the perigastric ligaments, then it should be performed gastric fixation after reset. Teague[2] reported that since 1996, the surgical treatment of gastric torsion has been performed laparoscopically, which has been proved to be not only safe and effective, but also suitable for both acute and chronic gastric torsion. We believe that laparoscopic surgery for acute and chronic gastric torsion, as long as the case selection is appropriate, and the intraoperative investigation excludes gastric ulcer disease, gastric cancer, esophageal hiatal hernia, diaphragmatic hernia and other causes of gastric ulcer disease, not only has the cosmetic advantage of small trauma to the abdominal wall, but also has the advantages of less bleeding than conventional caesarean section, a clear field of vision, easy to operate, safe and reliable, fast postoperative recovery, shorten hospitalization time, and has a definite effect, with fewer long-term complications.