Left iliac fossa sigmoidectomy with mechanical anastomosis in the management of uncomplicated sigmoid volvulus: an observational study at Principal Hospital of Dakar, Senegal.

Abstract

Introduction: sigmoidectomy is the definitive treatment of Sigmoid Volvulus (SV). It can be done either by laparotomy or laparoscopy. Our objective was to describe the left iliac fossa sigmoidectomy with mechanical anastomosis recently introduced in our practice, assess our results after 5 years and evaluate its feasibility in our setting.

Methods: we conducted a prospective, descriptive and analytic study on all patients admitted for uncomplicated SV with successful non-surgical decompression and treated by a left iliac fossa sigmoidectomy with mechanical anastomosis. This study was held, from May 2016 to May 2021, at the Visceral Surgery Department of Principal Hospital of Dakar, Senegal. We studied the demographic variables, the data of the preoperative planning (time between sigmoid decompression and surgery, moment of the sigmoidectomy, mechanical bowel preparation or not, type of anesthesia), the peroperative findings (length and diameter of the sigmoid loop), the surgical procedure (the type of staplers used for the mechanical anastomosis, the duration of the operation, incidents or accidents during sigmoidectomy), the immediate and long-term postoperative course.

Results: we collected 53 patients with a mean age of 50 years ± 17. They were 50 men and 3 women. Mechanical colonic preparation was performed in 18 patients (Group 1) and 35 patients did not benefit from a mechanical bowel preparation before surgery (Group 2). The mean length of the sigmoid loop was 74.5cm ± 16.5. The mean diameter of the descendant branch was 7.8cm ± 0.7 for Group 1 and 5.5cm ± 1 for Group 2 with p = 0.01. One linear cutter stapler was used for the side-to-side anastomosis. It was a 100mm in 43% (n=23) of cases. The terminalization of the side-to-side anastomosis was performed with 1 linear stapler in 37 cases, 2 linear staplers in 15 cases and 3 linear staplers in 1 case. The median duration of the operation was 50 minutes for Group 1 and 37 minutes for Group 2 with p = 0.004. Morbidity was nil in Group 1. In Group 2, we had 1 anastomotic leakage and 1 anastomotic stenosis. Mortality was nil in the 2 groups. The mean hospital stay was 5 days ± 3.7. The mean follow-up was 31 months with no recurrence or incisional hernia.

Conclusion: this surgical method is rapid, simple, reproducible and feasible in our setting with a good postoperative course. Colonic mechanical preparation may not be necessary.