Laparoscopy in the management of closed loop sigmoid volvulus

Area of Science:

• Colorectal surgery
• Minimally invasive surgery
• Gastroenterology

Background:

• Sigmoid volvulus is a common cause of large bowel obstruction, particularly in certain populations.
• Acute closed-loop sigmoid volvulus presents a surgical challenge.
• Traditional open surgery can be associated with significant morbidity.

Purpose of the Study:

• To evaluate the feasibility of elective laparoscopic surgery for acute closed-loop sigmoid volvulus.
• To assess the surgical outcomes of this minimally invasive approach.
• To determine the safety and efficacy of laparoscopic recto-sigmoidectomy post-colonoscopic decompression.

Main Methods:

• A prospective electronic database of colorectal laparoscopic procedures was reviewed.
• Nine consecutive patients with sigmoid volvulus underwent colonoscopic decompression followed by laparoscopic recto-sigmoidectomy during the same admission.
• Patient demographics, operative details, and postoperative outcomes were recorded.

Main Results:

• Seven of nine patients were women, with ages ranging from 37-87 years (median 64).
• Median operative time was 115 minutes, with no anastomotic complications.
• Seven patients had an uncomplicated recovery, with a median postoperative stay of 4 days. Complications included ileus, myocardial infarct, and wound infection in one patient each. One patient died from a brainstem infarct.

Conclusions:

• Laparoscopic recto-sigmoidectomy after colonoscopic decompression is a viable and safe option for managing sigmoid volvulus.
• The procedure is associated with minimal surgical complications.
• Patients experience a quick recovery, with short hospital stays.