Is Laparoscopy Underutilized for Sigmoid Volvulus?

Abstract

Purpose: Minimally invasive surgery has become increasingly prevalent. However, the majority of colectomies for volvulus are still performed via an open technique. The purpose of this study is to determine whether there is a difference in outcomes between laparoscopic and open procedures for sigmoid volvulus. Materials and Methods:The American College of Surgeons National Surgical Quality Improvement Program and colectomytargeted procedure databases were queried from 2013 to 2018. Patients undergoing partial colectomy without ileal resection for the indication of volvulus were compared based on approach (planned laparoscopic vs. planned open). The 2 groups were propensity score matched for perioperative variables. A subgroup analysis was performed comparing unplanned laparoscopic conversion to open (CTO) with planned open procedures. The primary outcomes were overall morbidity, mortality, and length of stay.Results: Total 2493 patients were identified. Four hundred ninety-two cases began laparoscopically (20%), of which 391 were completed laparoscopically (79%). Laparoscopic approach was associated with longer operative times (133 vs. 104 min, P < 0.001). Laparoscopic approach was associated with decreased overall morbidity (OR: 0.71, 95% CI, 0.54 to 0.93) and decreased length of stay when > 7 days (OR: 0.70, 95% CI, 0.52 to 0.94). On subgroup analysis, there was no difference in outcomes when comparing unplanned CTO to planned open approach.Conclusions: Laparoscopic approach is used in a fraction of cases for colonic volvulus. When utilized, the majority are completed without CTO. Laparoscopy is associated with fewer complications and shorter hospital stays. Even with unplanned conversion to open, there is no difference in outcomes compared against planned open procedures. Surgeons should consider the utilization of laparoscopy for colonic volvulus.

Elective Sigmoidectomy Laposcopic Assisted for Sigmoid Volvulus in a Rural Setting

“…Several approaches have been described: meso-sigmoidoplasty, open sigmoidopexy, endoscopic or laparoscopic, and elective sigmoidectomy, by median laparotomy or total laparoscopic or laparoscopic-assisted [2][3][4][5]. A systematic review and meta-analysis of the safety and efficacy of laparoscopic surgery in the management of sigmoid volvulus performed by Ndong A in 2022 including a total number of 30810 patients with 29874 cases of volvulus, showed that laparoscopic surgery was performed in only 7% of cases (N =2089) [6]. Several options are possible concerning this route: sigmoidectomy, sigmoidopexy, stoma inversion.…”

Sigmoid Volvulus and Ileosigmoid Knotting: An Update

“… 2 , 4 , 8 , 21 In this field, laparoscopic procedure with natural orifice specimen extraction is the current option. 71 On the other hand, patients with indefinite diagnosis, gangrenous stool, or peritoneal irritation findings during the admission in addition to unsuccessful endoscopic decompression are treated with emergency surgery. If the sigmoid colon is viable, surgical decompression alone (mortality 0%-5%, morbidity 5%-15%, and recurrence 15%-55%) may be performed, but a recurrence-reducing procedure such as sigmoidopexy, mesopexy, or mesoplasty (mortality 1%-10%, morbidity 10%-25%, and recurrence 10%-20%), or preferably sigmoid colectomy (mortality 1%-10%, morbidity 15%-25%, and recurrence 0%-1%) may also be added.…”

Management of Sigmoid Volvulus: A Literature Review

“…3 5 7 10 13 19 27 36 The mortality is 0 to 2%, the morbidity is 10 to 25%, and the recurrence is 0 to 1%. 1 3 5 10 19 24 26 36 42 43 In this field, the best innovation of the recent time is natural orifice specimen extraction with laparoscopic sigmoidectomy and primary anastomosis. 44 45 46…”

“…1E). 10,19,42,43 As an elective procedure, it is strongly recommended in well-conditioned and nonelderly patients to prevent SV recurrence. 3,5,7,10,13,19 Sigmoidectomy may be performed by open surgery or preferably laparoscopy, and following resection, stoma or preferably primary anastomosis is added.…”

“…3,5,7,10,13,19,27,36 The mortality is 0 to 2%, the morbidity is 10 to 25%, and the recurrence is 0 to 1%. 1,3,5,10,19,24,26,36,42,43 In this field, the best innovation of the recent time is natural orifice specimen extraction with laparoscopic sigmoidectomy and primary anastomosis. [44][45][46] Percutaneous endoscopic sigmoidopexy (PES; or PE colopexy or PE colostomy [PEC]) is the fixation of the apex of the sigmoid colon to the anterior abdominal wall by using endoscopic stoma kits (►Fig.…”