Evaluating outcomes of primary anastomosis versus Hartmann's procedure in sigmoid volvulus: A retrospective-cohort study

Shahmoradi, Mohammad Kazem; farahani, Parham khoshdani; Sharifian, Masoud

doi:10.1016/j.amsu.2021.01.019

Cited by 9 publications

(6 citation statements)

References 24 publications

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“…In our study all the cases were done as elective with careful and thorough preparation because even when volvulus is adequately treated mortality is in the region of 12-15%, according to various studies. In our study, there was a male dominance in admissions with recurrent volvulus which was 96.97% which is consistent with literature 8 . It is widely accepted that patients that do present with recurrent admissions have multiple co-morbities that can pose a significant risk to post-operative morbidity and also mortality 9 .…”

Section: I) Discussionsupporting

confidence: 92%

Outcome of Sigmoid Colectomy in patients with recurrent Sigmoid Volvulus. A single center experience from a Rural Hospital

Gandiya¹

2022

Isra Med J

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Objective: To assess the outcomes of definitive surgical management (sigmoid colectomy) in recurrent sigmoid volvulus. Study Design: Retrospective analytic study. Place and Duration: Department of Surgery at Balfour Hospital, Orkney, Scotland from 1st September 2014 to 1st September 2021. Methodology: Data of patients admitted with recurrent volvulus for three or more times and selected for surgery by a multiple disciplinary team retrieved. The median follow up of 32 (5-60) months was analyzed. The demographic features of the patient, symptoms, and complications after surgery, number of admissions before and after surgery and patient quality of life before and after surgery were analyzed. Results: A total of 33 patients were analyzed with an age ranges from 35 to 76 years with a median age of 55.5 years, M:F ratio of 12:2 and with duration of symptomatic volvulus 12 to 36 (median 24) months. Of the patients in the study, 24 patients had three previous admissions and 9 had more than three admissions with sigmoid volvulus that was managed conservatively. Complications experienced included post-operative ileus in 33.3%, wound infection 6%, and readmission with volvulus was 3.03% however 57.5% reported no complications. Conclusion: Our study concluded an excellent intermediate term outcome with very low clinical recurrence in patients who were offered definitive management following multiple admissions. Keywords: Sigmoid volvulus, Recurrent, Co-morbidities, Colectomy, Complications, Outcome

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Section: I) Discussionsupporting

confidence: 92%

Outcome of Sigmoid Colectomy in patients with recurrent Sigmoid Volvulus. A single center experience from a Rural Hospital

Gandiya¹

2022

Isra Med J

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“…The mortality we found was higher than that reported by Awedew (24) in Ethiopia (6.45%), Jumbi & Kuremu (25) in Kenya (3.3%) and Wismayer (10) in northern Uganda (7.7%). The differences seen in mortality could be because these studies that reported lower mortality had some patients operated electively after derotation yet in our study there were no facilities for endoscopic derotation, yet emergency procedures are associated with a higher mortality (15). Also the high percentage of patients with perforated sigmoid (18.5%) could have contributed to the high mortality.…”

Section: Resultsmentioning

confidence: 72%

“…A blood sample for serum electrolytes and complete blood count were taken. Antibiotics (ceftriaxone and metronidazole) were administered (15). At surgery the gut viability was assessed and the type of surgery done noted.…”

Section: Recruitment and Data Collection Proceduresmentioning

confidence: 99%

Clinical profile and Factors associated with adverse outcome following Surgery for Sigmoid Volvulus: A multi centre study

Khadolwa,

Muhumuza,

Abraha

et al. 2024

Preprint

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Introduction In Uganda, one of the leading causes of intestinal obstruction is sigmoid volvulus. Due to unavailability of endoscopic services in some settings, most of the patients usually undergo emergency surgery. The aim of this study was to determine the clinical profile and factors associated with early adverse outcome following surgery for sigmoid volvulus at Jinja, Hoima and Fortportal regional referral hospitals (FRRH, HRRH and FRRH respectively). Methods This was an observational prospective cohort done at 3 regional referral hospitals in Uganda. Patients undergoing surgery for sigmoid volvulus were enrolled consecutively and followed up till the time of discharge or death to document the mortality, occurrence of complications and length of hospital stay. Data analysis was done using SPSS version 26 with Poisson regression done to determine the factors. Results In this study that enrolled 81 participants, majority were males 63(77.8%) with a mean age of 55.1(SD=14.2) years. Hemodynamic instability was seen in 27(33.3%), non-viable gut in 27(33.3%) with colostomies placed in 61(75.3%) of the participants. Death occurred in 10(12.3%) of the patients, while 37(45.7%) had at least one complication with the commonest complication being surgical site infection 21(25.9%). The median length of hospital stay (LOS) was 8(IQR=7-11) days. At multivariate level of analysis, hyperkalemia (aRR=2.210, CI=1.512-3.630, P=0.024) and presence of a sigmoid perforation (aRR=1.913, CI=1.015-3.962, P<0.001) were independently associated with mortality, hypertension (aRR=2.726, CI=1.206-6.158, P=0.016) and presence of hemodynamic instability (aRR=2.500, CI=1.561-4.004, P<0.001) associated with occurrence of complications, while duration of symptoms greater than 3 days (aRR=1.217, CI=1.016-1.458, P=0.033) and hemodynamic instability (aRR=1.165, CI=1.017-1.335, P=0.028) were independently associated with prolonged hospital stay. Conclusion A big proportion of the participant’s presented with hemodynamic instability and non-viable gut resulting in placement of many colostomies. The mortality and morbidity were high as well as the length of hospital stay. More sensitization in relation to early presentation to hospital is still needed in order to reduce the number of patients that present with hemodynamic instability and non-viable or perforated sigmoid which in turn could improve the outcomes.

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“…The impact of fluid and electrolyte imbalance on mortality rates has not been considered in great detail. A recent study found similar rates of mortality, anastomotic leakage, bleeding, surgical site infection, and wound dehiscence between primary anastomosis and the Hartmann procedure [30]. The most current ASCRS guidelines recommend primary anastomosis in elective cases unless the patient's risk factors conflict with this [31].…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological Features of Elderly Patients with Colonic Volvulus

Gul,

Oğuz Aşlayan,

Çorbacı

et al. 2024

Eur J Ther

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Objective: Sigmoid volvulus is most commonly seen in patients between 60 and 80 years old. The management of volvulus depends on its location and clinical presentation. The fundamental aspects of treatment include evaluating the viability of the colon, relieving the obstruction, and preventing the possibility of recurrence. We aimed to present the clinicopathological characteristics of geriatric colonic volvulus patients treated in a single center. Methods: Patients diagnosed with colonic volvulus and treated in this hospital were included in the study. Mortality rates of patients who underwent and did not undergo preoperative colonoscopic detorsion were compared statistically. In addition, diseases that affect the quality of life and cause deterioration in bowel movements and habits were determined, and these diseases' effect on mortality was evaluated. Results: Forty-four patients who underwent emergency surgery due to volvulus were included in our study. There was sigmoid colon perforation in two patients and cecum perforation in 1 patient. Two patients had cecal volvulus, and right hemicolectomy was performed in these patients; anastomosis was performed in one, and ileostomy was performed in the other. Sigmoid resection was performed in 36 patients, subtotal colectomy in 5 patients, right hemicolectomy in 2 patients, and sigmoidopexy with laparotomy and reduction in 1 patient. Thirteen patients (29.5%) underwent preoperative colonoscopy, and in eight cases, the procedure was conducted a day before the surgery, with the operation being carried out semi-urgently the next day. Conclusion: Intestinal volvulus is a rare condition that can occur in any part of the large intestine. However, it is a severe medical issue that requires prompt diagnosis and treatment due to the possibility of intestinal damage and mortality.

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Evaluating outcomes of primary anastomosis versus Hartmann's procedure in sigmoid volvulus: A retrospective-cohort study

Cited by 9 publications

References 24 publications

Outcome of Sigmoid Colectomy in patients with recurrent Sigmoid Volvulus. A single center experience from a Rural Hospital

Outcome of Sigmoid Colectomy in patients with recurrent Sigmoid Volvulus. A single center experience from a Rural Hospital

Clinical profile and Factors associated with adverse outcome following Surgery for Sigmoid Volvulus: A multi centre study

Clinicopathological Features of Elderly Patients with Colonic Volvulus

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