Elective laparoscopically assisted sigmoidectomy for the sigmoid volvulus

  • J.-T. LiangEmail author
  • H.-S. Lai
  • P.-H. Lee



The laparoscopic approach for the treatment of sigmoid volvulus has been a rare surgical indication. This phase 2 study investigated the feasibility and surgical outcomes of elective laparoscopic surgery for sigmoid volvulus.


Patients with sigmoid volvulus were first offered colonoscopic decompression for their acute colonic obstruction. If the colonic decompression was successful, complete bowel preparation was performed, followed by elective laparoscopically assisted sigmoidectomy. The details of the laparoscopic procedures are shown in the video. Briefly, the redundant sigmoid colon is totally mobilized by a laparoscopic medial-to-lateral dissection sequence, after which it is exteriorized, transected, and reconstructed by end-to-end anastomosis. In the authors’ experience, the medial-to-lateral approach is highly efficient for the laparoscopic mobilization of the redundant sigmoid colon. We believe that the longer the lateral abdominal wall attachment of the sigmoid colon is preserved, the better the exposure and the easier the dissection. If the risk of anastomotic leakage is considered high in a specific case, protective ileostomy is selectively preformed. Before entering the current study, the patients were well informed about the advantages and disadvantages of laparoscopic surgery. The enrollment of patients was selective according to the appropriate eligibility criteria. This study was approved by the Institutional Review Board of the National Taiwan University Hospital. The patients’ clinicopathologic data and surgical outcomes were prospectively evaluated.


Between August 2001 and April, 2005, a total of 14 patients (10 men and 4 women) with sigmoid volvulus were treated with the described procedure. The age distribution of the patients was 68.4 ± 12.2 years. The attack of sigmoid volvulus was the first episode for eight patients, the second episode for 4 patients, and the third episode (or more) for two patients. The body mass index (BMI) of the patients was 26.8 ± 4.4 kg/m2. The physical status (classification of American Society of Anesthesiology [ASA]) was 1 for five patients, 2 for eight patients, and 3 for 1 patient. During the laparoscopy, all the patients presented with the pathognomonic findings of sigmoid volvulus including redundant sigmoid colon, narrow sigmoid mesenteric pedicle, and mesosigmoiditis with mesenteric fibrosis and scarring, as shown in the video. The length of the resected colon was 32 ± 6 cm. The operation time was 194.6 ± 32.4 min, and the blood loss was 44.0 ± 12.4 ml. The abdominal wound consisted of four 5- to 12-mm working ports and a 5-cm major wound for exteriorization of the sigmoid colon. Some surgeons have shown that a sigmoid volvulus can be resected through a 5-cm left lower quadrant incision with very little mobilization of the colon because of its redundancy. In this context, the laparoscopic approach competed with the minilaparotomy method in terms of adequate sigmoid resection, lysis of mesosigmoid adhesion, and tension-free colorectal anastomosis. Protective ileostomy was performed for the only patient with a physical status of ASA 3. There was no mortality in this case series. However, pneumonia developed postoperatively in one patient, acute myocardial infarction in one patient, and wound infection in two patients. Excluding the two patients who experienced postoperative pneumonia and acute myocardial infarction, the duration of the postoperative ileus was 48 ± 12 h, the postoperative hospitalization was 7 ± 1 days, and the degree of postoperative pain was 3.5 ± 0.5 according to the visual analog scale. The return to partial activity required 18 ± 2.5 days, and the return to full activity required 28.4 ± 5.6 days. As compared with the overall costs for a conventional sigmoid colectomy, which are completely covered by the National Bureau of Health Insurance of Taiwan, the expenses for the patients undergoing laparoscopic procedures were significantly higher by approximately NT$24,000.0 ± 2,635.0 (1 U.S. dollar = 32 NT$). These higher expenses must be borne by the patients themselves.


Considering that patients with sigmoid volvulus often are elderly and chronically ill, laparoscopic elective surgery after a successful colonoscopic decompression may be a good choice for a selected group of patients in terms of minimized surgical complications and quick convalescence.


Laparoscopic surgery Sigmoid volvulus 

Supplementary material

Video contribution


  1. 1.
    Chung CC, Kwok SPY, Leung KL, et al. (1997) Laparoscopy-assisted sigmoid colectomy for volvulus. Surg Laparosc Endosc 7: 423–425 (Original ref 3)PubMedCrossRefGoogle Scholar
  2. 2.
    Chung RS (1997) Colectomy for sigmoid volvulus. Dis Colon Rectum 40: 363–365 (Original ref 6)PubMedCrossRefGoogle Scholar
  3. 3.
    Fleshman JW (1999) Laparoscopic management of colonic volvulus. Semin Colon Rectal Surg 10: 154–157 (Original ref 1)Google Scholar
  4. 4.
    Liang JT, Lai HS, Huang KC, et al. (2003) Comparison of medial-to-lateral versus traditional lateral-to-medial dissection sequences for the resection of rectosigmoid cancers: a randomized controlled clinical trial. World J Surg 27: 190–196 (Original ref 5)PubMedCrossRefGoogle Scholar
  5. 5.
    Liang JT, Shieh MJ, Chen CN, et al. (2002) Prospective evaluation of laparoscopy-assisted colectomy versus laparotomy with resection in the management of complex polyps of the sigmoid colon. World J Surg 26: 377–383 (Original ref 4)PubMedCrossRefGoogle Scholar
  6. 6.
    Peters WR, Fleshman JW (1995) Minimally invasive colectomy in elderly patients. Surg Laparosc Endosc 5: 477–479 (Original ref 7)PubMedGoogle Scholar
  7. 7.
    Sundin JA, Wasson D, McMillen MM, et al. (1992) Laparoscopic-assisted sigmoid colectomy for sigmoid volvulus: brief clinical report. Surg Laparosc Endosc 2: 353–358 (Original ref 2)PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  1. 1.Division of Colorectal Surgery, Department of SurgeryNational Taiwan University Hospital and College of MedicineTaipeiROC

Personalised recommendations