Appropriateness of Prophylactic Surgery for Sigmoid Volvulus in View of Recurrence and Nutritional Status

Background  Sigmoid volvulus causes colonic obstruction and ischemia. Urgent surgery is required for colonic necrosis or perforation, whereas prophylactic surgery is recommended after endoscopic treatment in nonemergency cases. However, many patients with sigmoid volvulus only undergo endoscopic treatment, highlighting a gap between guideline recommendations and clinical practice. We aimed to elucidate the actual management and outcomes of sigmoid volvulus in hospitalized patients to reconsider the disadvantages of delaying prophylactic surgery. Methods  We retrospectively recruited patients with sigmoid volvulus who were treated at the Hoshigaoka Medical Center between January 2013 and September 2024. Participant demographics and outcomes were analyzed, and the probability of remaining recurrence-free was estimated using Kaplan-Meier analysis. Wilcoxon signed-rank tests were used to compare paired samples. Results  We enrolled 28 participants with sigmoid volvulus. Of these, 15 (53%) had a medical history of cerebral stroke, and 12 (42%) were institutionalized. No participants who underwent surgery experienced recurrence, whereas 10 (62%) of 16 participants who received only endoscopic treatment did. Among patients with recurrence, one died as a result. Body weight, serum albumin level, geriatric nutritional risk index, and prognostic nutritional index were significantly lower at the time of recurrence than at the first hospitalization. No deaths occurred due to postoperative complications. Conclusions Sigmoid volvulus frequently recurs after endoscopic treatment alone, posing a life-threatening risk with each recurrence. Most patients with sigmoid volvulus are frail, and their nutritional status often deteriorates before recurrence occurs. Prophylactic surgery should therefore be planned for sigmoid volvulus soon after endoscopic treatment for the first time.