Ambiguities in Sigmoid Volvulus Management: Developing a Framework for Optimal Management Strategies

Area of Science:

• Gastroenterology and Hepatology
• Surgical Gastroenterology
• Colorectal Surgery

Background:

• Sigmoid volvulus (SV) is a significant cause of large bowel obstruction, often managed endoscopically.
• High recurrence rates (45-71%) following endoscopic decompression create ambiguity in definitive treatment strategies.
• Current management lacks clear guidelines for choosing between elective surgery and repeated endoscopic interventions.

Purpose of the Study:

• To develop evidence-based guidelines for the management of sigmoid volvulus within a UK National Health Service (NHS) trust.
• To evaluate the effectiveness of current management strategies and identify factors influencing recurrence and outcomes.
• To provide a framework for optimal decision-making regarding surgical intervention versus conservative management.

Main Methods:

• Retrospective study analyzing data from 42 patients with sigmoid volvulus over three years.
• Data collection included diagnostic modalities (AXR, CT), endoscopic decompression success rates, comorbidities (CCI), and recurrence rates.
• Kaplan-Meier analysis was used to assess recurrence-free survival.

Main Results:

• A majority of patients (76.2%) had moderate to severe comorbidities.
• Endoscopic decompression was successful in all cases, but 35.7% experienced recurrences, often within 90 days.
• Only 11.9% underwent definitive surgery, typically after multiple recurrences, indicating a potential delay in surgical consideration.

Conclusions:

• Developed local guidelines for expedited SV management, aligning with international recommendations.
• Advocates for a holistic approach integrating early surgical intervention with comorbidity assessment.
• Early surgical decisions can significantly reduce recurrences, hospital readmissions, morbidity, and associated healthcare costs.