Management of early recurrence following successful endoscopic detorsion in sigmoid volvulus.

Abstract

Objectives: Following endoscopic detorsion, sigmoid volvulus (SV) recurs in 3%-86% of patients, approximately 13% of which are early recurrence presenting during the first admission period. Although semielective surgery is the traditional approach, elective surgery following repetitive endoscopy or percutaneous endoscopic sigmoidopexy (PES) are other alternatives in the management of early SV recurrence. Our aim was to discuss the role of semielective surgery in above-mentioned rare clinical entity.

Methods: Among our 1,076-case series, we retrospectively evaluated the records of 612 patients (56.9%) treated between June 1966 and June 1986, while we prospectively utilized the data of 464 patients (43.1%) managed between June 1986 and January 2024. We recorded the treatment option and prognosis for each patient.

Results: Early SV recurrence was determined in 34 (5.5%) of the 621 patients with successful nonoperative detorsion. We treated all of these patients by semielective surgery. The surgical procedures were detorsion in one patient (2.9%), mesopexy in 11 (32.4%), sigmoidectomy with primary anastomosis in 17 (50.0%), and sigmoidectomy with stoma in five (14.7%). In this series, mortality and morbidity rates were 2.9% (one patient) and 14.7% (five patients), respectively.

Conclusion: Semielective surgery is the traditional approach tried by most surgeons, which allows for the recovery of the general status of the patients, bowel preparation, and antibiotic prophylaxis. However, repetitive endoscopy followed by elective surgery or PES are current alternatives for some selected patients. Unfortunately, the relatively low effectuation rate of elective surgery following successful repetitive endoscopic detorsion and recurrence-related poor prognosis are still important handicaps of the latter procedure.