Tomonori Imakita1, Yutaka Suzuki1, Hironori Ohdaira1, Mitsuyoshi Urashima2. 1. Department of Surgery, Graduate School of Medical Sciences, International University of Health and Welfare, Tochigi, Japan. 2. Department of Molecular Epidemiology, Jikei University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND AND AIMS: Many patients with sigmoid volvulus are old with co-morbidities, making elective surgery prohibitive. Colonoscopic management is often successful but volvulus often recurs. We devised a method of colonoscopy-assisted percutaneous sigmoidopexy as an alternative method to prevent recurrence of sigmoid volvulus. This study aimed to assess its safety and effectiveness. METHODS: Patients with sigmoid volvulus American Society of Anesthesiologists physical status classification ≥3 or Barthel index <30 were included. We excluded patients with intestinal necrosis and those who were unable to be repositioned but who could undergo intestinal resection. Colonoscopy-assisted sigmoidopexy was performed under radiographic observation. First, a colonoscope was inserted to the fixation site. A site for percutaneous puncture of the colon was identified by transmitted illumination and finger pressure. An exploratory puncture through the abdominal wall was made with a 23-gauge cattelan needle with the patient under local anesthesia, followed by a skin incision. Sigmoid fixation was then performed using a 2-shot anchor device that allows the sigmoid colon to be sutured to the abdominal wall. Fixation was repeated at 5 to 10 sites (average 8.8). The primary outcome measurement was sigmoid volvulus recurrence within 12 months. The secondary outcome measurement was adverse events. RESULTS: Eight patients received colonoscopy-assisted sigmoidopexy, and no sigmoid volvulus recurred during the 12-month follow-up period. One case of postoperative subcutaneous emphysema was successfully managed with conservative therapy. CONCLUSION: Colonoscopy-assisted sigmoidopexy was an effective, safe alternative method to prevent the recurrence of sigmoid volvulus.
BACKGROUND AND AIMS: Many patients with sigmoid volvulus are old with co-morbidities, making elective surgery prohibitive. Colonoscopic management is often successful but volvulus often recurs. We devised a method of colonoscopy-assisted percutaneous sigmoidopexy as an alternative method to prevent recurrence of sigmoid volvulus. This study aimed to assess its safety and effectiveness. METHODS:Patients with sigmoid volvulus American Society of Anesthesiologists physical status classification ≥3 or Barthel index <30 were included. We excluded patients with intestinal necrosis and those who were unable to be repositioned but who could undergo intestinal resection. Colonoscopy-assisted sigmoidopexy was performed under radiographic observation. First, a colonoscope was inserted to the fixation site. A site for percutaneous puncture of the colon was identified by transmitted illumination and finger pressure. An exploratory puncture through the abdominal wall was made with a 23-gauge cattelan needle with the patient under local anesthesia, followed by a skin incision. Sigmoid fixation was then performed using a 2-shot anchor device that allows the sigmoid colon to be sutured to the abdominal wall. Fixation was repeated at 5 to 10 sites (average 8.8). The primary outcome measurement was sigmoid volvulus recurrence within 12 months. The secondary outcome measurement was adverse events. RESULTS: Eight patients received colonoscopy-assisted sigmoidopexy, and no sigmoid volvulus recurred during the 12-month follow-up period. One case of postoperative subcutaneous emphysema was successfully managed with conservative therapy. CONCLUSION: Colonoscopy-assisted sigmoidopexy was an effective, safe alternative method to prevent the recurrence of sigmoid volvulus.