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Laparoscopic fixation of volvulus by extra-peritonealization: a case series

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Abstract

Background

Volvulus is one of the leading causes of colonic obstruction with a high recurrence rate following endoscopic decompression. Although colonic resection remains the treatment of choice, it is often associated with significant morbidity and mortality, especially in elderly patients. Colonic fixation with extra-peritonealization has been suggested as an alternative to colonic resection. The aim of this study was to evaluate the surgical outcomes of patients with colonic volvulus in our initial experience with this procedure.

Methods

A retrospective analysis of a prospectively maintained database of all patients who underwent colonic extra-peritonealization for volvulus between January 2016 and April 2021 in Sheba medical center (Ramat-Gan, Israel) was performed. Patients’ demographics, clinical, peri-operative and post-operative data were recorded and analyzed.

Results

One hundred and thirty nine patients were admitted due to acute colonic volvulus, 48 of whom were treated surgically. Eleven patients underwent extra-peritonealization of the sigmiod or cecum during the study period. Mean age was 64.5 years. Six patients (54.55%) were males. Seven patients (63.63%) presented with sigmoid volvulus and 4 (36.36%) with cecal volvulus. Median American Society of Anesthesiologists (ASA) class was 3 (range 2–4). One patient (9.09%) was required urgent surgery. The majority of patients was operated on using a laparoscopic approach (10 patients, 90.9%). Median length of stay was 3 days (range 1–6 days) and no post-operative complications or readmissions within 30 days after surgery were recorded. Median length of follow-up was 283 days (range 21–777 days). During the follow-up period, three patients (27.27%) presented with recurrent volvulus and required an additional surgical intervention with colonic resection. Of the patients with volvulus recurrence, one patient (9.09%) required an urgent surgical intervention.

Conclusions

Extra-peritonealization of colonic volvulus is feasible and safe. Although recurrence rates are fairly high, the low morbidity associated with the procedure makes it an appealing alternative to colonic resection, especially in patients with high risk for post-operative complications.

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Author notes

  1. Mor Aharoni and Yaniv Zager have equal contribution to this manuscript.

Authors and Affiliations

  1. Department of General Surgery and Transplantation, Sheba Medical Center, Affiliated to the Faculty of Medicine, Tel Aviv University, 52621, Tel Hashomer, Israel

    M. Aharoni, Y. Zager, S. Khalilieh, I. Amiel, N. Horesh, E. Ram, M. Gutman & D. Rosin

  2. Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, FL, USA

    N. Horesh

  3. Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA

    S. Khalilieh

Authors
  1. M. Aharoni
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  2. Y. Zager
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  3. S. Khalilieh
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  4. I. Amiel
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  5. N. Horesh
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  6. E. Ram
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  7. M. Gutman
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  8. D. Rosin
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Corresponding author

Correspondence to Y. Zager.

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None of the authors have financial or other conflicts of interests regarding our study: Laparoscopic fixation of volvulus by extra-peritonealization—a case series.

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Aharoni, M., Zager, Y., Khalilieh, S. et al. Laparoscopic fixation of volvulus by extra-peritonealization: a case series. Tech Coloproctol 26, 489–493 (2022). https://doi.org/10.1007/s10151-022-02596-y

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  • DOI: https://doi.org/10.1007/s10151-022-02596-y

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