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LETTER TO THE EDITOR
Mini Laparotomy for Sigmoid Volvulus
Khalid Hureibi
1
Elgeilani Elzaidi
1
Charles Evans
1
ÓSocie
´te
´Internationale de Chirurgie 2018
Dear Editor,
We want to command Dr van der Naald and colleagues
on their published series on surgical treatment for
uncomplicated volvulus [1].
We have the following comments:
First, we appreciate the rural setting in Zambia and the
unavailability of flexible sigmoidoscopy for decompres-
sion. In our hospital, we do not have this service out of
hours (after 5 pm). However, we find tube decompression
by rigid sigmoidoscopy very helpful and usually have
dramatic results. This can give longer time for fluid
resuscitation and electrolyte correction. It can also change
an urgent situation to a ‘‘semi-elective’’ one—with all the
advantages associated. Additionally, it helps us to assess
acutely whether there is any tissue necrosis. Atamanalp
reported 35.3% morbidity and 16.1% mortality for emer-
gency procedures versus 12.5 and 0% for elective proce-
dures, respectively, for sigmoid volvulus [2].
Second, a median stay of 4 days is impressive; however,
this might pose a potential problem in such a rural setting,
and loss of follow-up. We believe, in such rural setting
where transport is difficult, it might be perilous to dis-
charge the patients early knowing the potential lack of
post-discharge support to manage any leaks which might
happen post day 4. Short hospital stay should be a means to
an end, not an end in itself. In fact, hospital stay was not
one of the key elements that affected the outcome in ERAS
in emergency surgery as shown by Gonenc et al. [3]. We do
not agree that low septic complications rate in this series
can be correlated to the median stay as was alluded to in
the discussion. The small number of patients, the loss of
follow-up and other confounding variables make it difficult
to conclude this.
Third, smaller incisions are desirable, but sometimes
such small incisions might fail to remove the entire length
of redundant colon and, therefore, increase the risk of post-
resection recurrence. Hence, the surgeon should never
hesitate to extend the incision if needed. This is even more
valid for the young age population as opposed the old and
frails.
Fourth, we wonder in what situations the authors would
elect to perform a proximal diversion when performing the
anastomosis.
Yours sincerely,
Khalid Hureibi
Elgeilani Elzaidi
Charles Evans
References
1. van der Naald N, Prins MI, Otten K, Kumwenda D, Bleichrodt RP
(2017) Novel approach to treat uncomplicated sigmoid volvulus
combining minimally invasive surgery with enhanced recovery, in
a rural hospital in Zambia. World J Surg. https://doi.org/10.1007/
s00268-017-4405-9
2. Atamanalp S (2013) Treatment of sigmoid volvulus: a single-
center experience of 952 patients over 46.5 years. Tech Coloproc-
tol 17(5):561–569
3. Gonenc M, Dural AC, Celik F, Akarsu C, Kocatas A, Kalayci MU,
Alis H (2014) Enhanced postoperative recovery pathways in
emergency surgery: a randomised controlled clinical trial. Am J
Surg 207(6):807–814
&Khalid Hureibi
alhureibi@gmail.com
1
Department of Colorectal Surgery, University Hospital,
Coventry, UK
123
World J Surg
https://doi.org/10.1007/s00268-018-4507-z
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Article
Aim: In sub-Saharan Africa, sigmoid volvulus is a frequent cause of bowel obstruction. The aim of this study was to evaluate the results of acute sigmoid resection and anastomosis via a mini-laparotomy in patients with uncomplicated sigmoid volvulus, following the principles of "Enhanced Recovery After Surgery (ERAS)", in a low-resource setting. Materials and methods: Patients with uncomplicated sigmoid volvulus were operated acutely, via a mini-laparotomy, according to the principles of ERAS. Intraoperative complications, duration of operation, morbidity, mortality and length of hospital stay were evaluated, retrospectively. Results: From 1 March 2012 to 1 September 2017, 31 consecutive patients were treated with acute sigmoid resection and anastomosis, via a mini-laparotomy. There were 29 men and 2 women, median age 57 (range 17-92) years. Patients were operated after a median period of 4 (range 1.5-18) hours. The median duration of the operative procedure was 50 (range 30-105) minutes. Two patients died (6.3%). One patient died during an uncomplicated operation. The cause of death is unknown. One patient with a newly diagnosed HIV infection had an anastomotic dehiscence. After Hartmann's procedure, he died on the 17th post-operative day as a result of a HIV-related double-sided pneumonia, without signs of abdominal sepsis. One patient had an urinary retention and 1 patient haematuria after bladder catheter insertion. Conclusion: Acute sigmoid resection and primary anastomosis via a mini-laparotomy for uncomplicated sigmoid volvulus, without preoperative endoscopic decompression is a safe procedure with a low morbidity and mortality.
Article
Background: Sigmoid volvulus describes the wrapping of the sigmoid colon around itself and its mesentery, causing an intestinal obstruction. The aim of this study was to assess the outcomes of 952 patients treated for sigmoid volvulus over a period of 46.5 years. Methods: Clinical records were reviewed retrospectively. Results: Nonsurgical detorsion was performed in 686 patients with 77.1 % success, 2.5 % morbidity, 0.7 % mortality, and 4.5 % early recurrence rates; emergency surgical procedures were performed in 447 patients with 35.3 % morbidity, 16.1 % mortality, 0.7 % early recurrence, and 7.4 % late recurrence rates, while elective surgical treatment was performed in 104 patients with 12.5 % morbidity, no mortality, and no recurrence. Conclusions: The principal strategy in the treatment for sigmoid volvulus is early nonsurgical detorsion followed by elective surgery in uncomplicated patients, while emergency surgical treatment is performed for patients with bowel gangrene, perforation, or peritonitis, other difficulties with diagnosis, unsuccessful nonsurgical detorsion, and early recurrence.