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Contemporary Management of Sigmoid Volvulus

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Sigmoid volvulus is an uncommon cause of bowel obstruction that is historically associated with high morbidity and mortality. The objective of this study was to evaluate contemporary management of sigmoid volvulus and the safety of primary anastomosis in patients with sigmoid volvulus.

Methods

The National Surgical Quality Improvement Project from 2012 to 2015 was queried for patients with colonic volvulus who underwent left-sided colonic resection. A propensity score-matched analysis was performed to compare patients with sigmoid volvulus undergoing colectomy with primary anastomosis without proximal diversion to colectomy with end colostomy.

Results

Two thousand five hundred thirty-eight patients with sigmoid volvulus were included for analysis. Patients had a median age of 68 years (interquartile range, 55–80) and 79% were fully independent preoperatively. Fifty-one percent of operations were performed emergently. One thousand eight hundred thirteen (71%) patients underwent colectomy with anastomosis, 240 (10%) colectomy with anastomosis and proximal diversion, and 485 (19%) colectomy with end colostomy. Overall, 30-day mortality and morbidity were 5 and 40%, respectively. After propensity score matching, mortality, overall morbidity, and serious morbidity were similar between groups.

Conclusions

Sigmoid volvulus occurs in elderly and debilitated patients with significant morbidity, mortality, and lifestyle implications. In selected patients, anastomosis without proximal diversion in patients with sigmoid volvulus results in similar outcomes to colectomy with end colostomy.

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Authors and Affiliations

  1. Department of Surgery, Indiana University School of Medicine, 1801 N. Senate Blvd., Suite 635, Indianapolis, IN, 46202, USA

    Scott C. Dolejs, Michael J. Guzman, Alyssa D. Fajardo, Bryan K. Holcomb, Bruce W. Robb & Joshua A. Waters

Authors
  1. Scott C. Dolejs
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  2. Michael J. Guzman
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  3. Alyssa D. Fajardo
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  4. Bryan K. Holcomb
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  5. Bruce W. Robb
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  6. Joshua A. Waters
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Contributions

Drs. Dolejs, Guzman, Fajardo, Holcomb, Robb, and Waters made substantial contributions to the conception of the work, revision of the work for important intellectual content, final approval of the version to be published, and agreement to be accountable for all aspects of the work. Drs. Dolejs and Waters made substantial contributions to the acquisition, analysis, and interpretation of data, and drafted the work.

Corresponding author

Correspondence to Joshua A. Waters.

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Conflicts of Interest

The authors declare that they have no conflicts of interest.

Additional information

This was presented as a poster at the American Society of Colon and Rectal Surgeons Tripartite Meeting on June 10–14, 2017, in Seattle, Washington. Manuscript has not been previously published and is not under consideration by another publication or electronic medium.

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Dolejs, S.C., Guzman, M.J., Fajardo, A.D. et al. Contemporary Management of Sigmoid Volvulus. J Gastrointest Surg 22, 1404–1411 (2018). https://doi.org/10.1007/s11605-018-3747-4

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  • DOI: https://doi.org/10.1007/s11605-018-3747-4

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