Assessment of Recurrence Rate After Sigmoidopexy for Acute Sigmoid Volvulus

Introduction:

Colonic volvulus, a significant cause of large bowel obstruction, occurs when a segment of the colon twists, obstructing normal bowel function. Among the different types of colonic volvulus, acute sigmoid volvulus (SV) is the most common, with a high incidence in certain regions, such as the "twist belt" in Africa, Ethiopia, East Asia, and Australia, where its frequency can exceed 50%. SV frequently presents as either partial or complete bowel obstruction, leading to ischemia, necrosis, and potential perforation if untreated. The morbidity and mortality associated with SV are substantial, particularly in elderly patients. Prompt management is crucial to reduce complications and improve patient outcomes.

Treatment Approaches:

The primary goal of treatment is to relieve the obstruction and address the twisted portion of the colon. The World Society of Emergency Surgery (WSES) recommends endoscopic decompression for patients without signs of severe infection, perforation, or hemodynamic instability. If decompression fails, or if necrosis is present, surgical intervention is necessary. Surgical options include sigmoidopexy, sigmoidectomy, mesenteroplasty, or colostomy. Sigmoidopexy is less invasive but carries a higher risk of recurrence, whereas sigmoidectomy, though more complex, may reduce recurrence and improve long-term survival.

Despite various treatment options, the optimal approach remains unclear due to inconsistencies in the existing literature. This study compares two commonly used surgical methods-sigmoidopexy and sigmoidectomy-to assess their outcomes in terms of SV recurrence, complications, and overall survival.