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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