Emergency primary anastomosis with or without intraoperative colonic lavage following sigmoidectomy in sigmoid volvulus: 175-patient experience in a tertiary referral hospital.

Abstract

Objectives: Emergency primary anastomosis following sigmoidectomy is one of the main treatment options in sigmoid volvulus (SV). However, during this procedure, the role of intraoperative colonic lavage (ICL) is controversial. Our aim was to evaluate the role of ICL in 175-patient SV series.

Methods: In Ataturk University Faculty of Medicine Department of General Surgery, ICL was applied in 76 cases (43.4%), while it was not used in the remained 99 patients (56.6%) in 58.5-year period. In a partial retrospective (first 20 years, from June 1966 to June 1986) and prospective (later 38.5 years, from June 1986 to December 2024) evaluation, some preoperative, operative, and postoperative findings were utilized.

Results: As preoperative data, mean age (56.4 years vs. 57.1 years, P>0.05), male/female ratio (4.8 vs. 4.2, P>0.05), and rate of shock (5.3% vs. 6.1%, P>0.05) were statistically similar in both groups, while mean ASA score (3.1 vs. 2.9, P<0.05) was significantly lower in ICL group. Among operative findings, rates of bowel gangrene (67.1% vs. 63.6%, P>0.05) and perforation (1.3% vs. 1.0%, P>0.05) were statistically similar in both groups, while mean operation time (205.4 minutes vs. 176.8 minutes, P<0.005) was significantly longer in ICL group. As surgical outcomes, rates of mortality (13.2% vs 12.1%, P>0.05) and morbidity (39.5% vs. 28.3%, P>0.05) were statistically similar in both groups, while mean hospitalization time (14.7 days vs. 9.4 days, P<0.001) was significantly longer and mean cost (3,455.4 USD vs. 2,752.1 USD, P<0.001) was significantly higher in ICL group.

Conclusion: When compared with that of primary anastomosis with ICL, primary anastomosis without ICL provided shorter operation and hospitalization times, and less cost in addition to similar mortality and morbidity rates in the emergency treatment of SV.