NONRESECTIVE ALTERNATIVE FOR THE CURE OF NONGANGRENOUS SIGMOID VOLVULUS

PURPOSE: Recurrence in sigmoid colon volvulus is a very vexing problem , because it occurs after all types of treatment including a resection of the sigmoid. A nonresective procedure that prevents recurrence in the long term has been devised and tried during the period 1968 to 199 2. METHODS: The procedure involves extraperitonealization of the whole sigmoid colon via a left paracolic gutter incision in a manner akin t o an extraperitonealized colostomy and placing it in the left half of the infraumbilical abdominal wall. This article presents a study of 84 patients who underwent this operation and who were followed-up. Some very useful practical points for ensuring the success of the procedure are also presented. RESULTS: The subjects comprised 58 male and 26 fe male patients, aged 10 to 81 (median, 60) years. The operating time ra nged from 40 to 70 (median, 50) min. The operative mortality (9 percen t) and morbidity of the procedure including cardiopulmonary complicati ons (7 percent), incidence of small-bower obstruction (1 percent), and incisional hernia formation (2.3 percent), were reasonably low. The i ncidence of wound-healing problems was significantly (P < 0.02) reduce d in the 1980s and 1990s. Seventy-six patients were available for foll ow-up ranging from 0.5 to 25 (mean +/- standard error, 6.671 +/- 0.573 ; median, 6) years. Forty-eight patients were followed-up far five or more years. No patients developed recurrence of volvulus during the en tire follow-up period. CONCLUSIONS: This nonresective, recurrence-free procedure provides a cure for nongangrenous sigmoid volvulus. It may be performed safely, even in relatively poor-risk patients, with accep tably low morbidity and mortality rates.