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Sigmoidectomy following sigmoid volvulus: who is at risk of anastomotic failure?

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Abstract

Background

Anastomotic leak following elective sigmoidectomy performed due to sigmoid volvulus (SV) is a devastating complication. The aim of this study was to identify the incidence and risk factors associated with leak in this specific group of patients.

Methods

A retrospective study was performed at two university-affiliated tertiary centres in Israel. All consecutive patients between January 2014 and April 2020 treated for SV with elective sigmoidectomy and primary anastomosis were reviewed and those suffering from anastomotic leak identified. Factors associated with this complication were assessed using univariate analysis and odds ratios subsequently calculated.

Results

Of the 99 patients initially identified, 58 were included in the study group [45 males and 13 females (77.6% versus 22.4% respectively) mean age 67.4 years, range 13–97]. There were 10 anastomotic leaks identified (17.2%). On univariate analysis recurrent decompression (OR 8.28, p = 0.027), age > 80-years (OR 6.88, p = 0.027), open rather than laparoscopic surgery (OR = 5.83, p = 0.005) and ASA grade 3/4 (OR 0.132, p = 0.023) were significantly associated with anastomotic leak. Male sex approached but not reach statistical significance.

Conclusions

Recurrent endoscopic decompression, age > 80 years, open surgery and ASA grade 3/4 are associated with anastomotic leak and these patients should be considered for formation of a colostomy instead. If an anastomosis is performed, patients should be appropriately counselled and monitored in the perioperative period.

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Availability of data and material

The datasets generated during the current study are available from the corresponding author and will be made available on request.

Code availability

Not applicable.

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Authors and Affiliations

  1. Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University School of Medicine, 12 Shmeul Bait Street, 9103102, Jerusalem, Israel

    J. Tankel, M. Zuckerman, R. Spira & S. Yellinek

  2. Division of General Surgery, Rambam Health Care Campus, Haifa, Israel

    H. Gilshtein & M. Neymark

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  1. J. Tankel
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  2. H. Gilshtein
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  4. M. Zuckerman
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  5. R. Spira
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  6. S. Yellinek
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by JT, HG, MN and MZ. The first draft of the manuscript was written by JT, HG, RS and SY. All authors commented on previous versions and read/approved the final version of the manuscript.

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Correspondence to J. Tankel.

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The authors declare that they have no conflict of interests.

Ethical approval

Approval was obtained from the ethics committee at the Shaare Tzedek Health Care Centre and Rambam Health Care Centre. In light of the retrospective and anonymous nature of the study, the requirement for informed consent was waived by the respective committees.

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Informed consent was not required for participation in this study.

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Tankel, J., Gilshtein, H., Neymark, M. et al. Sigmoidectomy following sigmoid volvulus: who is at risk of anastomotic failure?. Tech Coloproctol 25, 1225–1231 (2021). https://doi.org/10.1007/s10151-021-02508-6

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  • DOI: https://doi.org/10.1007/s10151-021-02508-6

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