Laparoscopic fixation of volvulus by extra-peritonealization: a case series

Area of Science:

• Surgical Gastroenterology
• Colorectal Surgery
• Minimally Invasive Surgery

Background:

• Colonic volvulus is a primary cause of intestinal obstruction with frequent recurrence after endoscopic decompression.
• Colonic resection, the standard treatment, carries substantial risks, particularly for elderly patients.
• Colonic extra-peritonealization presents a potential alternative to resection for colonic volvulus.

Purpose of the Study:

• To evaluate the surgical outcomes of colonic extra-peritonealization for colonic volvulus.
• To assess the feasibility and safety of this technique as an alternative to colonic resection.

Main Methods:

• Retrospective analysis of prospectively collected data from January 2016 to April 2021.
• Inclusion of patients who underwent colonic extra-peritonealization for volvulus at Sheba Medical Center.
• Recording and analysis of demographic, clinical, peri-operative, and post-operative data.

Main Results:

• Eleven patients underwent extra-peritonealization for sigmoid or cecal volvulus, with a median age of 64.5 years.
• Laparoscopic approach was used in 90.9% of cases, with a median length of stay of 3 days and no early complications.
• Three patients (27.27%) experienced recurrence during a median follow-up of 283 days, requiring further surgery.

Conclusions:

• Colonic extra-peritonealization is a feasible and safe procedure for managing colonic volvulus.
• The technique offers low morbidity, making it a viable option compared to colonic resection, especially for high-risk individuals.
• Despite a notable recurrence rate, the benefits outweigh the risks in selected patient populations.