How do surgeons manage sigmoid volvulus electively? Results of a nationwide practice survey (AFC-SFCD-FRENCH)

Sigmoid volvulus carries a high risk of recurrence despite effective endoscopic detorsion, and subsequent management remains heterogeneous, particularly with regard to indications, timing and technical modalities. This national survey aimed to characterize current practices for sigmoid volvulus in France, with a focus on decision-making after successful detorsion.

A national web-based survey was distributed between 01/07/25 and 01/11/25 to members of two major French societies in digestive surgery (the Société Française de Chirurgie Digestive (SFCD) and the Association Française de Chirurgie (AFC)) and one national collaborative research group (the French Federation of Surgical Research (FRENCH)). The questionnaire included 23 items addressing diagnostic assessment, emergency management, indications and timing of elective surgery, surgical approach, extent of resection and anastomotic strategy.

A total of 372 surgeons responded. After successful endoscopic detorsion, 69% of surgeons individualized the indication for elective surgery, which was performed during the same admission in 64% of cases. More than 90% of surgeons reported no strict upper age limit. An open approach was preferred by 52% of respondents. Colonic resection was almost systematic (99%), with an anastomosis performed in 98% of cases, most often colorectal (61%) and stapled (79%). Subgroup analyses showed that colorectal surgeons used more preoperative assessment tools, indocyanine green imaging and stapled colorectal anastomoses, whereas non-academic practice settings were mainly associated with delayed surgery.

Management of sigmoid volvulus remains heterogeneous in France. Surgical specialty and practice setting significantly influence preoperative assessment, operative strategy and timing, supporting the need for harmonized management guidelines.