Management of early recurrence following successful endoscopic detorsion in sigmoid volvulus:

Article Information

Title: Management of early recurrence following successful endoscopic detorsion in sigmoid volvulus:

Authors: Nurhak Aksungur, Esra Disci, Rifat Peksoz, Sabri Selcuk Atamanalp

Journal: Pakistan Journal of Medical & Cardiological Review (PJMS)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31

Publisher: Intellect Educational Research Explorers

Country: Pakistan

Year: 2024

Volume: 40

Issue: 9

Language: English

DOI: 10.12669/pjms.40.9.10078

Keywords: Sigmoid VolvulusEarly recurrenceEndoscopic detorsion

Abstract

Objectives: Following endoscopic detorsion, sigmoid volvulus (SV) recurs in 3%-86% of patients, approximately 13% of which are early recurrence presenting during the first admission period. Although semielective surgery is the traditional approach, elective surgery following repetitive endoscopy or percutaneous endoscopic sigmoidopexy (PES) are other alternatives in the management of early SV recurrence. Our aim was to discuss the role of semielective surgery in above-mentioned rare clinical entity.
Methods: Among our 1,076-case series, we retrospectively evaluated the records of 612 patients (56.9%) treated between June 1966 and June 1986, while we prospectively utilized the data of 464 patients (43.1%) managed between June 1986 and January 2024. We recorded the treatment option and prognosis for each patient.
Results: Early SV recurrence was determined in 34 (5.5%) of the 621 patients with successful nonoperative detorsion. We treated all of these patients by semielective surgery. The surgical procedures were detorsion in one patient (2.9%), mesopexy in 11 (32.4%), sigmoidectomy with primary anastomosis in 17 (50.0%), and sigmoidectomy with stoma in five (14.7%). In this series, mortality and morbidity rates were 2.9% (one patient) and 14.7% (five patients), respectively.
Conclusion: Semielective surgery is the traditional approach tried by most surgeons, which allows for the recovery of the general status of the patients, bowel preparation, and antibiotic prophylaxis. However, repetitive endoscopy followed by elective surgery or PES are current alternatives for some selected patients. Unfortunately, the relatively low effectuation rate of elective surgery following successful repetitive endoscopic detorsion and recurrence-related poor prognosis are still important handicaps of the latter procedure.
doi: https://doi.org/10.12669/pjms.40.9.10078
How to cite this: Aksungur N, Disci E, Peksoz R, Atamanalp SS. Management of early recurrence following successful endoscopic detorsion in sigmoid volvulus. Pak J Med Sci. 2024;40(9):1985-1988. doi: https://doi.org/10.12669/pjms.40.9.10078
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer: The following sections are produced through an intensive multi-stage analytical pipeline developed by DefinePK, utilizing advanced natural-language processing, domain-specific knowledge models, and automated cross-referencing systems. Despite the rigor and computational effort involved, the generated summary may still contain inaccuracies or incomplete interpretations. Users are strongly advised to verify all critical information against the original paper and its authoritative sources.

Research Objective

To discuss the role of semielective surgery in the management of early sigmoid volvulus (SV) recurrence following successful endoscopic detorsion.

Methodology

Retrospective and prospective evaluation of 1,076 patients with sigmoid volvulus treated between June 1966 and January 2024. Data on treatment options and prognosis were recorded. Statistical analysis was performed using SPSS v22.0, with significance set at p<0.05.

Methodology Flowchart

                        graph TD
    A["Data Collection Retrospective & Prospective"] --> B["Patient Record Evaluation"];
    B --> C["Treatment Option & Prognosis Recording"];
    C --> D["Statistical Analysis"];
    D --> E["Identify Early Recurrence"];
    E --> F["Treatment of Early Recurrence Semielective Surgery"];
    F --> G["Analyze Outcomes Mortality, Morbidity"];
    G --> H["Compare Treatment Modalities"];
    H --> I["Formulate Conclusion"];

Discussion

Semielective surgery is a traditional approach for early SV recurrence, allowing for patient stabilization and bowel preparation. However, repetitive endoscopy followed by elective surgery or percutaneous endoscopic sigmoidopexy (PES) are alternatives for selected patients. The low effectuation rate of elective surgery and poor prognosis related to recurrence remain challenges.

Key Findings

Early SV recurrence was observed in 5.5% (34 out of 621 patients) with successful nonoperative detorsion. All these patients were treated with semielective surgery. Mortality and morbidity rates in this group were 2.9% and 14.7%, respectively. Elective surgery showed lower mortality (0.0%) and morbidity (11.2%) rates compared to emergency surgery.

Conclusion

Semielective surgery is the most preferred option for early SV recurrence, but repetitive endoscopy followed by elective surgery or PES are emerging alternatives for carefully selected patients, despite the challenges of elective surgery follow-up and recurrence-related poor prognosis.

Fact Check

1. Early SV recurrence was determined in 34 (5.5%) of the 621 patients with successful nonoperative detorsion. (Confirmed)
2. Mortality and morbidity rates in the semielective surgery group for early recurrence were 2.9% (one patient) and 14.7% (five patients), respectively. (Confirmed)
3. Elective surgery in 116 patients had no mortality and a morbidity rate of 11.2% (13 patients). (Confirmed)

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