Contemporary Management of Sigmoid Volvulus

Abstract

Sigmoid volvulus occurs in elderly and debilitated patients with significant morbidity, mortality, and lifestyle implications. In selected patients, anastomosis without proximal diversion in patients with sigmoid volvulus results in similar outcomes to colectomy with end colostomy.

Perioperative Outcomes and Predictors of Mortality After Surgery for Sigmoid Volvulus

“…19 Recent data on mortality rates in the United States after surgical intervention for sigmoid volvulus is limited and reported rates range from 5.4 to 10%. 6,9,20 Internationally from 1981 to 2012, the mortality rates after colon resection in studies with 5 or more patients ranged from 0 to 50% with an average of 12%, 21 with a reported mortality of 42% in patients with gangrenous bowel. 22 The overall mortality rate noted in our study for all patients undergoing surgery for sigmoid volvulus was 6.5%.…”

Colectomy for caecal and sigmoid volvulus: a national analysis of outcomes and risk factors for postoperative complications

“…Our goal was to identify these patients based upon the CPT codes of the operations A majority of reports in the literature are case reports or small single-institution series, although there are a handful of national database studies [7][8][9][10][11]. A recent NSQIP study identified 2538 patients who underwent left-sided resection for the diagnosis of volvulus and compared those who underwent resection with or without anastomosis [5]. After propensity score matching they found that mortality, overall morbidity and serious morbidity were the same between the two groups, with an anastomotic leak rate of 6.2%.…”

Response to “Comments on ‘Colectomy for caecal and sigmoid volvulus: a national analysis of outcomes and risk factors for postoperative complications’”

“…Second, our report of a lower mortality rate of 3.4% is comparable to a similar rate reported by Dolejs et al . of 5% . Although the data were similar for years, we included slightly different Current Procedural Terminology (CPT) codes that probably account for the absolute difference in morbidity and mortality rates.…”