Predictive Markers for Surgical Indication in Sigmoid Volvulus with Grade II Ischemia.

IF 0.8 Q4 SURGERY

Chirurgia Pub Date : 2025-06-01 DOI:10.21614/chirurgia.3148

Dimitrie Buşu, Vasile Sârbu, Mihaela Pundiche, Răzvan Cătălin Popescu, Daniel Ovidiu Costea, Ispas Viorel, Andrei Dumitru, Cristina Tocia, Ioana Popescu, Ispas Sorina, Nicoleta Leopa

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引用次数: 0

Abstract

Background: Grade II ischemia in sigmoid volvulus presents challenges in surgical decision-making. This study compares outcomes between patients undergoing sigmoid resection during the first episode versus at recurrence. Methods: A retrospective analysis of 63 patients with intraoperatively confirmed Grade II ischemia treated between 2018-2024 was performed. All underwent initial endoscopic decompression followed by surgical resection - either during the first episode (Group I, n=41) or at recurrence (Group II, n=22). Demographic, biochemical, and surgical outcomes were compared. Results: Biochemical markers - including white blood cell count, CRP, D-dimer, serum lactate, and creatinine - were significantly elevated in recurrent cases (all p 0.001). Lower blood pH values were observed in recurrent cases (7.23 vs. 7.29, p 0.001) consistent with systemic acidosis. Operative time and intraoperative blood loss were higher in the recurrent group, and primary anastomosis was performed only in the first-episode group. Postoperative complications were more common in recurrent cases (31.8% vs. 12.2%, p=0.064), and length of stay was longer (8.64 vs. 6.32 days, p 0.001). Conclusions: Delayed surgery at recurrence is associated with worsened inflammation, metabolic derangement, and higher surgical risk. Early surgery during the first episode offers better clinical outcomes.

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乙状结肠扭转伴II级缺血手术指征的预测指标。

背景：乙状结肠扭转II级缺血对手术决策提出了挑战。本研究比较了乙状结肠切除术患者在首次发作时与复发时的预后。方法：回顾性分析2018-2024年间63例术中确诊的II级缺血患者。所有患者在首次发作时（组1，n=41）或复发时（组2，n=22）均行内镜下减压后手术切除。比较人口学、生化和手术结果。结果：生化指标——包括白细胞计数、CRP、d -二聚体、血清乳酸和肌酐——在复发病例中显著升高（p均为0.001）。复发患者的血液pH值较低（7.23 vs. 7.29, p 0.001），与系统性酸中毒一致。复发组手术时间和术中出血量较高，仅首发组行一期吻合。复发患者术后并发症较多（31.8% vs. 12.2%, p=0.064），住院时间较长（8.64 vs. 6.32 d, p= 0.001）。结论：复发延迟手术与炎症恶化、代谢紊乱和更高的手术风险相关。早期手术在第一次发作提供更好的临床结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Chirurgia Medicine-Surgery

CiteScore

1.00

自引率

0.00%

发文量

审稿时长

4-8 weeks

期刊介绍： Chirurgia is a bimonthly journal. In Chirurgia, original papers in the area of general surgery which neither appeared, nor were sent for publication in other periodicals, can be published. You can send original articles, new surgical techniques, or comprehensive general reports on surgical topics, clinical case presentations and, depending on publication space, - reviews of some articles of general interest to surgeons from other publications. Chirurgia is also a place for sharing information about the activity of various branches of the Romanian Society of Surgery, information on Congresses and Symposiums organized by the Romanian Society of Surgery and participation notes in other scientific meetings. Letters to the editor: Letters commenting on papers published in Chirurgia are welcomed. They should contain substantive ideas and commentaries supported by appropriate data, and should not exceed 2 pages. Please submit these letters to the editor through our online system.