Outcomes of Delayed Laparoscopic Sigmoidectomy with Primary Anastomosis After Colonoscopy Sigmoid Devolvulation

Abstract

Abstract Background Sigmoid Volvulus is the consequence of the rotation of the superior mesosigmoid. Initial management in patients without signs of peritoneal irritation is endoscopic devolvulation with a flexible colonoscope. Laparoscopic sigmoidectomy with primary anastomosis after colonoscopy is a feasible procedure. It has shown reduction in morbidity and mortality. The objective of this study is to show the outcomes of performing a delayed sigmoidectomy with primary anastomosis after colonoscopy sigmoid devolvulation. Methods We conducted a descriptive, retrospective study of patients who underwent colonoscopy sigmoid devolvulation followed by a laparoscopic sigmoidectomy with primary anastomosis after 3 or 5 days following the colonoscopy. Sigmoid volvulus was diagnosed based on clinical and radiological findings. All patients underwent abdominopelvic X-Ray and CT scan was used to confirm and evaluate the concomitant complications. We exclude patients with generalized or localized peritonitis, free air, needing immediate surgery, with hemodynamic instability, acute or chronic malnutrition, noncontrolled intra-abdominal or systemic infections and comorbidities that contraindicate a laparoscopic approach. Results During the study period 67 patients underwent successful colonoscopy sigmoid devolvulation with delayed sigmoidectomy by single-port laparoscopy after 3 or 5 days following the procedure. Only one patient underwent anastomotic leakage. No recurrence rates were reported after two years of follow up. Conclusion Delayed single-port laparoscopic sigmoidectomy with primary anastomosis performed days after a sigmoid devolvulation is an effective approach on stable patients. Delaying the surgery must be a decision of the surgeon, based on the clinical state of the patient.