Minilaparotomy without general anesthesia for the treatment of sigmoid volvulus in high-risk patients: A case series of 4 patients

Enrique, Ernesto L.; Hamdy, Kareem A.

doi:10.1016/j.ijscr.2017.02.055

Cited by 5 publications

(5 citation statements)

References 14 publications

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“…The results of our study are similar to those of Seow-En and Seow-Choen, Tavassoli et al and Enrique et al, who performed a sigmoid resection for sigmoid volvulus via a mini-laparotomy in the left lower quadrant, under local anaesthesia [30][31][32]. Some patients received intraoperative sedation, as well.…”

Section: Discussionsupporting

confidence: 89%

Novel Approach to Treat Uncomplicated Sigmoid Volvulus Combining Minimally Invasive Surgery with Enhanced Recovery, in a Rural Hospital in Zambia

et al. 2017

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Section: Discussionsupporting

confidence: 89%

Novel Approach to Treat Uncomplicated Sigmoid Volvulus Combining Minimally Invasive Surgery with Enhanced Recovery, in a Rural Hospital in Zambia

et al. 2017

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“…The ndings obtained told us that ML is an independent contributor to accelerated stay program with the potential to enhance the recovery of patients, and this is in line with the current literature on the topic [4,33].…”

Section: Table 3 Postoperative Complicationssupporting

confidence: 85%

“…The second advantage is that midline incision can be easily converted into standard laparotomy in case of technical di culties encountered. This approach for sigmoid volvulus was advocated by van der Naald [32]; nonetheless, other locations for ML incision were described in the literature, namely vertical [33], horizontal [34], and oblique [35] incision in the left iliac fossa, and they certainly have their own merits. We consider optimal a reduced-in-size rectus muscle-sparing Kocher incision for cholecystectomy, and midline incision in the epigastrium not reaching the umbilicus for closure of perforated peptic ulcer, and this is in line with the literature [8] and, we are con dent, with personal experience of many surgeons.…”

Section: Table 3 Postoperative Complicationsmentioning

confidence: 99%

Mini-laparotomy in emergency general surgery in a second-level hospital in Zambia: a prospective cohort study

Karachentsev

Kadochi

2023

Preprint

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Background Being an integral part of the Enhanced Recovery After Surgery methodology, the mini-invasive surgical technique is an important factor in attenuating surgical stress and minimising the risk of postoperative complications. Here we present our experience of utilising the mini-laparotomy (ML) approach in emergency surgery.Methods This prospective clinical study included adult patients operated on for acute abdominal conditions at a second-level hospital in Zambia. Thirty-four patients were explored through ML, and another 34 participants had a standard laparotomy (SL) incision. The size of ML ranged from 6 to 12 cm, with the median being 10.5 cm. ML was not attempted in abdominal malignancy, generalised peritonitis, and as an approach for the relaparotomy procedures. Length of hospital of stay (LOS) and morbidity/mortality were primary endpoints. Secondary outcomes of interest included operating time (OT) and post-operative pain control. Continuous variables were presented as mean with standard deviation or median with ranges; categorical data were given as proportions and percentages. Associations between data were estimated using the t-test and chi-square analysis, as appropriate. LOS was compared by log-rank test and presented graphically by Kaplan-Meier survival curves. A p-value < 0.05 was considered statistically significant.Results The most common procedures performed through ML were resection of the small bowel or colon, closure of hollow viscus perforation or rupture, and adhesiolysis. Employment of ML was associated with reduced LOS (p = 0.0002), shorter OT (p = 0.0003), and minimised need for opioid analgesia (p = 0.01); however, the difference in postoperative complications was not statistically significant (ML: 21% versus SL: 27%, p = 0.57), and mortality was similar (6% in each group).Conclusions As our data showed, ML is a feasible and safe technique that could be used in emergency visceral surgery and abdominal trauma in well-selected patients. Having comparable postoperative morbidity with the SL approach, it might lead to reduced pain and enhanced recovery after the procedure. We proposed an algorithm for the selection of exploration method in patients presented with acute abdominal conditions that could be of help to acute care surgeon operating in a resource-limited setting.

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“…In our initial experience with six patients during the past 2.5 years, the procedure was straight forward, and technically less challenging than the laparoscopic approach. In agreement, others have supported that that left iliac fossa mini-incision without laparoscopy has excellent results and could also be undertaken under local anesthesia [ 8 , 20 , 21 ]. Furthermore, in the rare event of failed exteriorization (e.g., in obese patients) of which we did not encounter any, the procedure could be converted to the open or laparoscopic approach.…”

Section: Discussionmentioning

confidence: 87%

Left iliac fossa mini-incision sigmoidectomy for treatment of sigmoid volvulus. Case series of six patients from Qatar

Al‐Dhaheri

Nada

Ansari

et al. 2020

International Journal of Surgery Case Reports

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Highlights Midline laparotomy is the classical treatment for sigmoid volvulus after initial colonoscopic decompression. Application of novel technique in treating sigmoid volvulus by left iliac fossa mini-incision successfully applied to six patients. Left iliac fossa mini incision for sigmoid volvulus is safe, feasible, cosmetically appealing and with low morbidity.

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Minilaparotomy without general anesthesia for the treatment of sigmoid volvulus in high-risk patients: A case series of 4 patients

Abstract: HighlightsSigmoid colectomy under local anesthesia, with or without intravenous conscious sedation, is feasible.A minimally invasive technique that spares general anesthesia to high risk patients.Development of new surgical techniques will be important in an aging population.

Cited by 5 publications

References 14 publications

Novel Approach to Treat Uncomplicated Sigmoid Volvulus Combining Minimally Invasive Surgery with Enhanced Recovery, in a Rural Hospital in Zambia

Novel Approach to Treat Uncomplicated Sigmoid Volvulus Combining Minimally Invasive Surgery with Enhanced Recovery, in a Rural Hospital in Zambia

Mini-laparotomy in emergency general surgery in a second-level hospital in Zambia: a prospective cohort study

Left iliac fossa mini-incision sigmoidectomy for treatment of sigmoid volvulus. Case series of six patients from Qatar

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