Niels van der Naald1,2, Marloes I Prins1, Kars Otten1, Dayson Kumwenda1, Robert P Bleichrodt3. 1. Department of Surgery, Saint Francis Mission Hospital, Private Bag 11, Katete (Eastern Province), Zambia. 2. Department of Surgery, Amsterdam Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. 3. Department of Surgery, Saint Francis Mission Hospital, Private Bag 11, Katete (Eastern Province), Zambia. robert.bleichrodt@gmail.com.
Abstract
AIM: In sub-Saharan Africa, sigmoid volvulus is a frequent cause of bowel obstruction. The aim of this study was to evaluate the results of acute sigmoid resection and anastomosis via a mini-laparotomy in patients with uncomplicated sigmoid volvulus, following the principles of "Enhanced Recovery After Surgery (ERAS)", in a low-resource setting. MATERIALS AND METHODS: Patients with uncomplicated sigmoid volvulus were operated acutely, via a mini-laparotomy, according to the principles of ERAS. Intraoperative complications, duration of operation, morbidity, mortality and length of hospital stay were evaluated, retrospectively. RESULTS: From 1 March 2012 to 1 September 2017, 31 consecutive patients were treated with acute sigmoid resection and anastomosis, via a mini-laparotomy. There were 29 men and 2 women, median age 57 (range 17-92) years. Patients were operated after a median period of 4 (range 1.5-18) hours. The median duration of the operative procedure was 50 (range 30-105) minutes. Two patients died (6.3%). One patient died during an uncomplicated operation. The cause of death is unknown. One patient with a newly diagnosed HIV infection had an anastomotic dehiscence. After Hartmann's procedure, he died on the 17th post-operative day as a result of a HIV-related double-sided pneumonia, without signs of abdominal sepsis. One patient had an urinary retention and 1 patient haematuria after bladder catheter insertion. CONCLUSION: Acute sigmoid resection and primary anastomosis via a mini-laparotomy for uncomplicated sigmoid volvulus, without preoperative endoscopic decompression is a safe procedure with a low morbidity and mortality.
AIM: In sub-Saharan Africa, sigmoid volvulus is a frequent cause of bowel obstruction. The aim of this study was to evaluate the results of acute sigmoid resection and anastomosis via a mini-laparotomy in patients with uncomplicated sigmoid volvulus, following the principles of "Enhanced Recovery After Surgery (ERAS)", in a low-resource setting. MATERIALS AND METHODS:Patients with uncomplicated sigmoid volvulus were operated acutely, via a mini-laparotomy, according to the principles of ERAS. Intraoperative complications, duration of operation, morbidity, mortality and length of hospital stay were evaluated, retrospectively. RESULTS: From 1 March 2012 to 1 September 2017, 31 consecutive patients were treated with acute sigmoid resection and anastomosis, via a mini-laparotomy. There were 29 men and 2 women, median age 57 (range 17-92) years. Patients were operated after a median period of 4 (range 1.5-18) hours. The median duration of the operative procedure was 50 (range 30-105) minutes. Two patients died (6.3%). One patient died during an uncomplicated operation. The cause of death is unknown. One patient with a newly diagnosed HIV infection had an anastomotic dehiscence. After Hartmann's procedure, he died on the 17th post-operative day as a result of a HIV-related double-sided pneumonia, without signs of abdominal sepsis. One patient had an urinary retention and 1 patienthaematuria after bladder catheter insertion. CONCLUSION: Acute sigmoid resection and primary anastomosis via a mini-laparotomy for uncomplicated sigmoid volvulus, without preoperative endoscopic decompression is a safe procedure with a low morbidity and mortality.
Authors: Eva B Deerenberg; Joris J Harlaar; Ewout W Steyerberg; Harold E Lont; Helena C van Doorn; Joos Heisterkamp; Bas Pl Wijnhoven; Willem R Schouten; Huib A Cense; Hein Bac Stockmann; Frits J Berends; F Paul Hlj Dijkhuizen; Roy S Dwarkasing; An P Jairam; Gabrielle H van Ramshorst; Gert-Jan Kleinrensink; Johannes Jeekel; Johan F Lange Journal: Lancet Date: 2015-07-15 Impact factor: 79.321
Authors: Pascal H E Teeuwen; Robert P Bleichrodt; Paul J M de Jong; Harry van Goor; Andre J A Bremers Journal: Dis Colon Rectum Date: 2011-07 Impact factor: 4.585