Modification of mesosigmoidoplasty for nongangrenous sigmoid volvulus.

Mesosigmoidoplasty is a nonresective procedure for nongangrenous sigmoid volvulus. It aims to correct the main pathogenetic factor of this condition, the narrow but long mesosigmoid. Although it had been demonstrated by intraoperative measurements that this has indeed achieved its purpose, recurrent volvulus has been reported after the procedure. This has raised the question of whether an operation on the mesosigmoid's peritoneal cover alone is sufficient to maintain the change in shape. The modification presented here aims at more sustainable shortening and widening of the mesosigmoid by including all its layers in the procedure. Of 31 consecutive patients with sigmoid volvulus operated on in Malawi in East Africa, 14 had the nongangrenous variety. Twelve of them underwent modified mesosigmoidoplasty without any major perioperative complications. There was one relaparotomy following misdiagnosis of cryptic Hirschsprung's disease and one true recurrence secondary to a technical error during the previous operation. During a follow-up of eight patients for 4 to 8 months, there were no complaints about abdominal discomfort or changed stool habits. Thus including all layers of the mesosigmoid in the plastic procedure did not increase short-term morbidity and in theory should be advantageous in respect to preventing recurrence. Applying it to a larger series with prolonged follow-up seems to be justified.