Surgical Management of Sigmoid Volvulus: A Multicenter Observational Study

Area of Science:

• Gastroenterology
• Surgical Oncology
• Colorectal Surgery

Background:

• Sigmoid volvulus is a common cause of large bowel obstruction, particularly in certain populations.
• Surgical intervention is often required for definitive management of sigmoid volvulus.
• Real-world data on surgical outcomes for sigmoid volvulus are crucial for optimizing patient care.

Purpose of the Study:

• To evaluate real-world clinical outcomes in patients surgically treated for sigmoid volvulus.
• To compare outcomes between emergency and elective surgical approaches.
• To assess the impact of surgical approach (laparoscopic vs. open) on patient outcomes.

Main Methods:

• Retrospective analysis of 74 patients undergoing surgery for sigmoid volvulus across five tertiary centers.
• Data collection spanned October 2003 to September 2018.
• Outcomes assessed included operation time, postoperative hospitalization, and morbidity for laparoscopic/open and elective/emergency procedures.

Main Results:

• Sigmoidectomy was the most frequent procedure. Emergency surgery (47.3%) was associated with higher rates of open surgery (97.1%) and stoma formation (74.3%).
• Elective surgery (52.7%) included a significant proportion of laparoscopic procedures (46.2%).
• Emergency surgery cases had a higher complication rate (40.0%) than elective cases (15.4%, P = 0.034). Median laparoscopic operation time was 180 minutes vs. 130 minutes for open surgery (P < 0.001).

Conclusions:

• Emergency surgery for sigmoid volvulus is linked to increased postoperative complications, open surgery, and stoma rates compared to elective surgery.
• Elective laparoscopic surgery, particularly after successful sigmoidoscopic decompression, represents a potentially optimal treatment strategy.
• Optimizing surgical timing and approach can improve outcomes for patients with sigmoid volvulus.