Choosing the Right Approach: Laparoscopic Versus Open Surgery for Cecal Volvulus

BackgroundCecal volvulus, a common cause of large bowel obstruction, is a surgical emergency because it can rapidly progress to life-threatening complications such as perforation, bowel necrosis, and sepsis. Although open surgical approaches predominate, laparoscopic approaches are increasingly utilized. This study compares postoperative outcomes in patients undergoing laparoscopic vs open colectomy for cecal volvulus using a large-scale national database.Materials and MethodsNational Surgical Quality Improvement Program 2012-2023 was queried for patients with cecal volvulus. Multivariable logistic regression was used to compare 30-day outcomes between patients who underwent laparoscopic and open colon resection for management of cecal volvulus while adjusting for demographics, baseline characteristics, and operative approaches. Continuous variables were adjusted using a generalized linear model.ResultsThere were 2663 patients and 451 patients who underwent open and laparoscopic colectomy for cecal volvulus, respectively. Compared to open surgery, patients with laparoscopic surgery had comparable mortality rates and significantly lower odds of postoperative complications including sepsis, unplanned return to OR, discharge not to home, postoperative ileus, anastomotic leak, pulmonary complications, and bleeding requiring transfusion (P < 0.05). Laparoscopic surgery had significantly longer operative times (118.60 minutes vs 92.28 minutes, P < 0.01) and shorter hospital length of stay (5.63 days vs 7.48 days, P < 0.01) when compared to open surgery.DiscussionDespite longer operative times associated with laparoscopic colectomy for cecal volvulus, patients had shorter hospital stays and were less likely to experience postoperative complications. These results suggest that laparoscopic colectomy should be considered for the management of cecal volvulus.