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Contemporary Management of Sigmoid Volvulus
Scott C Dolejs1, Michael J Guzman1, Alyssa D Fajardo1
1Department of Surgery, Indiana University School of Medicine, 1801 N. Senate Blvd., Suite 635, Indianapolis, IN, 46202, USA.
Summary
Primary anastomosis for sigmoid volvulus is safe. This surgical approach in selected patients showed similar outcomes to colectomy with end colostomy, reducing morbidity and mortality risks.
Area of Science:
- Colorectal Surgery
- Surgical Outcomes
- Gastrointestinal Surgery
Background:
- Sigmoid volvulus is a rare cause of bowel obstruction.
- It is associated with significant morbidity and mortality.
- Contemporary management strategies are under evaluation.
Purpose of the Study:
- To assess current management of sigmoid volvulus.
- To determine the safety of primary anastomosis in sigmoid volvulus patients.
Main Methods:
- Analysis of the National Surgical Quality Improvement Project (2012-2015).
- Inclusion of patients with colonic volvulus undergoing left-sided colectomy.
- Propensity score-matched analysis comparing primary anastomosis versus end colostomy.
Main Results:
- 2,538 patients with sigmoid volvulus were analyzed.
- Colectomy with anastomosis was performed in 71% of patients.
- After matching, mortality and morbidity were similar between primary anastomosis and end colostomy groups.
Conclusions:
- Sigmoid volvulus impacts elderly and debilitated patients.
- Anastomosis without proximal diversion is a safe option for selected sigmoid volvulus patients.
- Outcomes are comparable to colectomy with end colostomy.
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