Is Laparoscopy Underutilized for Sigmoid Volvulus?

Area of Science:

• Colorectal surgery
• Minimally invasive surgery
• Surgical outcomes research

Background:

• Minimally invasive surgery (MIS) is increasingly common, yet open colectomy remains standard for sigmoid volvulus.
• This study investigates the comparative effectiveness of laparoscopic versus open colectomy for sigmoid volvulus.

Purpose of the Study:

• To compare outcomes between laparoscopic and open colectomy for sigmoid volvulus.
• To evaluate the impact of surgical approach on morbidity, mortality, and length of stay.

Main Methods:

• Analysis of the American College of Surgeons National Surgical Quality Improvement Program and colectomy-targeted procedure databases (2013-2018).
• Propensity score matching of patients undergoing partial colectomy for volvulus based on planned laparoscopic versus planned open approach.
• Subgroup analysis comparing unplanned laparoscopic to open conversion (CTO) with planned open procedures.

Main Results:

• Laparoscopic colectomy was associated with longer operative times but decreased overall morbidity (OR: 0.71) and shorter length of stay (OR: 0.70 for >7 days).
• Of 492 cases initiated laparoscopically, 79% were completed without conversion to open surgery.
• Unplanned conversion to open surgery showed no significant difference in outcomes compared to planned open procedures.

Conclusions:

• Laparoscopic colectomy for sigmoid volvulus is associated with improved outcomes, including reduced morbidity and shorter hospital stays.
• The majority of laparoscopic procedures for sigmoid volvulus are completed successfully without conversion.
• Surgeons should consider laparoscopy for sigmoid volvulus, as it offers benefits even when conversion to open surgery is necessary.