S S Gupta1, O Singh, D Paramhans, R K Mathur. 1. Department of Surgery, MGM Medical College, MY Hospital, Indore 452001, India. drguptashilpi@gmail.com
Abstract
OBJECTIVE: To compare the effectiveness of tube sigmoidostomy and sigmoidopexy as effective treatment options for patients with acute uncomplicated sigmoid volvulus. METHODS: The records of 72 patients with acute uncomplicated sigmoid volvulus with obstruction who were treated by tube sigmoidostomy (Group I: n=32) and sigmoidopexy (Group II: n=40) were reviewed retrospectively. Follow-up period was 22 months (range: 6-51 months). RESULTS: Results show significant improvement in postoperative tachycardia, respiratory distress and urine output in Group I patients as compared to those in Group II. Most of the clinical parameters of Group I patients normalized by day 3, while it took up to 7 days in Group II patients. Intraabdominal hypertension caused by persistent colonic dilatation after sigmoidopexy was found to be an important determinant of postoperative morbidity. As compared to tube sigmoidostomy, the sigmoidopexy group had delayed recovery, more chances of abdominal fascial dehiscence, and longer hospital stay, as well as more prolonged abdominal discomfort, constipation, and recurrent volvulus rates during follow-up. CONCLUSION: Tube sigmoidostomy provides both fixation and decompression of the redundant sigmoid colon in the postoperative period while allowing time to recover from massive dilatation and edema caused by prolonged volvulus. Compared with sigmoidopexy for the treatment of uncomplicated sigmoid volvulus, tube sigmoidostomy leads to lesser rates of morbidity and recurrence. Thus, it can be considered as a definitive alternative treatment option for uncomplicated sigmoid volvulus.
OBJECTIVE: To compare the effectiveness of tube sigmoidostomy and sigmoidopexy as effective treatment options for patients with acute uncomplicated sigmoid volvulus. METHODS: The records of 72 patients with acute uncomplicated sigmoid volvulus with obstruction who were treated by tube sigmoidostomy (Group I: n=32) and sigmoidopexy (Group II: n=40) were reviewed retrospectively. Follow-up period was 22 months (range: 6-51 months). RESULTS: Results show significant improvement in postoperative tachycardia, respiratory distress and urine output in Group I patients as compared to those in Group II. Most of the clinical parameters of Group I patients normalized by day 3, while it took up to 7 days in Group II patients. Intraabdominal hypertension caused by persistent colonic dilatation after sigmoidopexy was found to be an important determinant of postoperative morbidity. As compared to tube sigmoidostomy, the sigmoidopexy group had delayed recovery, more chances of abdominal fascial dehiscence, and longer hospital stay, as well as more prolonged abdominal discomfort, constipation, and recurrent volvulus rates during follow-up. CONCLUSION:Tube sigmoidostomy provides both fixation and decompression of the redundant sigmoid colon in the postoperative period while allowing time to recover from massive dilatation and edema caused by prolonged volvulus. Compared with sigmoidopexy for the treatment of uncomplicated sigmoid volvulus, tube sigmoidostomy leads to lesser rates of morbidity and recurrence. Thus, it can be considered as a definitive alternative treatment option for uncomplicated sigmoid volvulus.