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Novel Approach to Treat Uncomplicated Sigmoid Volvulus Combining Minimally Invasive Surgery with Enhanced Recovery,
Niels van der Naald1,2, Marloes I Prins1, Kars Otten1
1Department of Surgery, Saint Francis Mission Hospital, Private Bag 11, Katete (Eastern Province), Zambia.
World Journal of Surgery
|December 23, 2017
Summary
Acute sigmoid resection and anastomosis using a mini-laparotomy is a safe and effective treatment for sigmoid volvulus in sub-Saharan Africa. This approach, following Enhanced Recovery After Surgery (ERAS) principles, shows low morbidity and mortality rates in low-resource settings.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Public Health
Background:
- Sigmoid volvulus frequently causes bowel obstruction in sub-Saharan Africa.
- Management often involves complex procedures, posing challenges in low-resource settings.
Purpose of the Study:
- To evaluate the outcomes of acute sigmoid resection and anastomosis via mini-laparotomy.
- To assess the feasibility of applying Enhanced Recovery After Surgery (ERAS) principles in this context.
Main Methods:
- Retrospective analysis of 31 patients with uncomplicated sigmoid volvulus.
- Acute sigmoid resection and anastomosis performed via mini-laparotomy under ERAS guidelines.
- Evaluation of intraoperative complications, operative duration, morbidity, mortality, and hospital stay.
Main Results:
- Median operative time was 50 minutes, with a median follow-up of 4 hours.
- Overall mortality was 6.3% (2 patients), with one death during surgery and another post-operative death related to HIV complications.
- Low rates of morbidity were observed, including urinary retention and hematuria.
Conclusions:
- Acute sigmoid resection with primary anastomosis via mini-laparotomy is a safe procedure for uncomplicated sigmoid volvulus.
- This approach demonstrates low morbidity and mortality, even without preoperative endoscopic decompression.
- The ERAS protocol can be successfully implemented in low-resource settings for this condition.