We read the article written by Satheakeerthy et al. 1 on the acute and elective treatment of sigmoid volvulus (SV). Our comments relate to the details of SV management based on our 1071-case experience treated over 57-year period from June 1966 to July 2023, which series contains the most comprehensive single-centre SV data over the world. 2 In SV, current guidelines advise flexible endoscopic decompression in patients without bowel ischaemia and perforation. 3 Although rigid endoscopes are commonly used due to their availability, accessibility, and cheapness, most practitioners favour flexible instruments over rigid endoscopes because of their higher success and lower complication rates. 4 Hence, in our 777-case endoscopy experience, the success rates are 84.8% versus 81.8%, while the mortality and morbidity rates are 0.2% versus 0.9% and 1.2% versus 2.6%, respectively, in flexible and rigid endoscopy groups. In this series, bowel perforation was seen in one of 351 patients (0.3%) treated with rigid endoscope. Nevertheless, we exactly disused rigid endoscopes in 2003. However, 5-case perforation ratio (3.0% in 168 trying) in the authors' series is relatively high. Inadequate visualization, severe manipulation, excessive air insufflation, and blind flatus tube application are common causes of perforation. 4 Second, current guidelines recommend elective sigmoid colectomy with primary anastomosis in selected patients. 3 Elective surgery may be performed with acceptable mortality (0%-2% vs. 1%-30%) and morbidity (5%-15% vs. 5%-60%) rates when compared with that of acute surgery, as was demonstrated by the authors. Hence, in our series, the mortality and morbidity rates are 0% and 11.3%, respectively, in 115-case elective surgery group, while these rates are 17.3% and 34.2%, respectively, in 486-patient acute surgery group. We recommend elective surgery, particularly laparoscopic procedure, in most American Society of Anesthesiologists score 1-3 cases younger than 75 years old. 2 We congratulate the authors and we look forward to their reply.