Recurrence–Preventive Role of Flatus Tubes Following Endoscopic Decompression in Sigmoid Volvulus

Abstract

Background: Sigmoid volvulus may recur following endoscopic decompression. Flatus tubes are traditionally used to prevent an early recurrence. This study aims to evaluate the recurrence–preventive role of the flatus tubes in sigmoid volvulus. Methods: Sigmoid volvulus recurrence was retrospectively analyzed in prospectively collected clinical data of endoscopically decompressed 60 patients, in whom no tube, rectal tube, or sigmoidal tube was used. Results: Mean pain/discomfort scores were higher in rectal and sigmoidal tube groups than that of no tube group (1.2 ± 0.4, 4.2 ± 0.9, and 3.5 ± 0.9, respectively, P < .001). The early recurrence was seen in 3 patients in the no tube group, while no early recurrence was determined during tube placement in the rectal and sigmoidal tube groups (15.0%, 0.0%, and 0.0%, respectively, P < .05, P < .05, and P > .05). The tubes were removed or spontaneously discharged in 13 (65.0%) and 12 patients (60.0%) in the rectal and sigmoidal tube groups, respectively, and sigmoid volvulus recurred in 2 patients in each group following the removal or spontaneous discharge. There was no statistically significant difference between the early recurrence rates of the no tube, rectal tube, and sigmoidal tube groups following the removal or spontaneous discharge of the tubes (15.0%, 15.4%, 16.7%, respectively, P > .05) and in total (15.0%, 10.0%, and 10.0%, respectively, P > .05). Conclusion: Flatus tubes may prevent the early volvulus recurrence during their placement in sigmoid volvulus. Nevertheless, they generally cause pain and discomfort, and they are frequently removed or spontaneously discharged, which suppresses their recurrence–preventive effects.

Management of Sigmoid Volvulus: A Literature Review

“…3,5,7,13 Similarly, data obtained from actual reviews and large series articles support this idea. 2,[14][15][16][17][18][19][20] Additionally, although randomized controlled data are sufficient to evaluate its role, the placement of a flatus tube proximal to obstruction for 24 to 72 hours is traditionally advocated to prevent an early recurrence. 7,9,14,15 The success of endoscopic detorsion is reported to be between 55 and 96%.…”

“…2,[14][15][16][17][18][19][20] Additionally, although randomized controlled data are sufficient to evaluate its role, the placement of a flatus tube proximal to obstruction for 24 to 72 hours is traditionally advocated to prevent an early recurrence. 7,9,14,15 The success of endoscopic detorsion is reported to be between 55 and 96%. 2,5,7,9,14,19,[21][22][23] This procedure may be performed with 0 to 10% of mortality and 1 to 25% of morbidity rates.…”

“…2,5,9,10,13,17,19,20,24,27,28 Recurrence An elongated and dilated sigmoid colon with a long mesentery, dolichosigmoid, is the main factor in the development of both primary and recurrent SV. 15,23,[28][29][30][31][32] Other factors affecting recurrence are advanced age, male gender, early onset, highfiber diet, high altitude, and chronic constipation. 29 Although the extension of the sigmoid colon to the subphrenic space and the decrease of left lateral hepatic section volume are suspected as recurrence-augmentative findings in computed tomography, increased maximal sigmoid colon distention is the most effective precursor relating to dolichosigmoid.…”

“…In the utilization of the recurrence-preventive procedures in SV, almost of the current guidelines, reviews, and large series articles use two important criteria for case selection: general performance status (well-conditioned or poor-conditioned) and age (elderly or nonelderly). 2,3,5,7,[13][14][15][16][17][18][19][20][22][23][24][26][27][28] However, as objective criteria, the American Society of Anesthesiologists (ASA) scoring system is a better parameter in the evaluation of the general status, and life expectancy is superior to age limit when elderliness is taken into consideration. 19 Therefore, we offer elective laparoscopic sigmoid colectomy with primary anastomosis in patients with ASA scores of 1 to 3 and younger than life expectancy, while patients with ASA scores greater than 3 and older than the above-mentioned life expectancy limit are potential individuals for other minimal invasive procedures including sigmoidopexy, mesopexy, mesoplasty, extraperitonealization, and preferably endoscopic percutaneous sigmoidopexy.…”

Comments on “Percutaneous Endoscopic Sigmoidopexy: Still a Way to Go”

“…I read the paper written by Garrido et al [ 1 ] on a patient with recurrent sigmoid volvulus (SV) treated with percutaneous endoscopic sigmoidopexy (PES) following second endoscopic detorsion (ED). Although ED is successful in approximately four-fifths of patients, SV tends to recur in approximately one-third of patients, and approximately one-seventh of patients are diagnosed with short- or medium-term recurrences, which generally occur during the index admission period [ 2 , 3 ]. Most probably due to the relatively low incidence of the early recurrence, the treatment algorithm is not clearly identified [ 4 ].…”