Comparison of primary resection and anastomosis with hartmann's procedure in management of acute sigmoid volvulus
DOI:
https://doi.org/10.18203/2349-2902.isj20163577Keywords:
Hartmann’s procedure, Resection anastomosis, Sigmoid volvulusAbstract
Background: Sigmoid volvulus is a common surgical emergency in many regions of the world, with significant morbidity and mortality. Volvulus occurs when an air-filled segment of the colon twists about its mesentery. In developing countries it is a major cause of colonic obstruction. The sigmoid colon is involved in up to 90% of cases. It can be present as acute, sub-acute or chronic. Emergency operation is needed in acute sigmoid volvulus. Various methods are used in the management. The purpose of our study was to evaluate the comparative study of single-stage resection and anastomosis with Hartmann’s procedure for management of acute left-sided colonic obstruction due to acute sigmoid volvulus.
Methods: This retrospective study was conducted in a consecutive series of 122 patients, admitted to M. K. C. G. Medical College in the department of general surgery, with acute sigmoid volvulus. Then laparotomy were carried out in all 122 patients, primary resection of the affected sigmoid colon with anastomosis were done in 87 patients and the surgical resection of the recto-sigmoid colon with closure of the rectal stump and formation of an end colostomy (Hartmann's procedure) in 35 patients were done in different groups. Outcome of the two procedures analyzed in terms of mortality, post-operative complications, and hospital stay.
Results: This study clearly showed that there is no such statistically significant result compared to both groups. Except little bit longer hospital stay in resection and anastomosis group than Hartmann’s group.
Conclusions: This study demonstrated that outcome of two procedures are same. Resection and anastomosis should be done in uncomplicated acute sigmoid volvulus safely, but in case of complicated patients Hartmann’s procedure is the choice of operation.
References
Katsikogiannis N, Machairiotis N, Zarogoulidis P, Sarika E, Stylianaki A, Zisoglou M, et al. Management of sigmoid volvulus avoiding sigmoid resection. Case Rep Gastroenterol. 2012;6:293-9.
Avots-Avotins KV, Waugh DE. Colon volvulus and the geriatric patient. Surg Clin North Am. 1982;62:248-60.
Raveenthiran V. Observations on the pattern of vomiting and morbidity in patients with acute sigmoid volvulus. J Postgrad Med. 2004;50:27-9.
Naaeder SB, Archampong ED. One-stage resection of acute sigmoid volvulus. Br J Surg. 1995;82:1635-6.
Welch GH, Anderson JR. Acute volvulus of the sigmoid colon. World J Surg. 1987;11:258-62.
Lal SK, Morgenstern R, Vinjirayer EP, Matin A. Sigmoid volvulus an update. Gastrointest Endosc Clin N Am. 2006;16(1):175-87.
Cuschieri A, Steele PJC, Moosa AR. Disorders of the colon and rectum. In: Essential Surgical Practice. 4th edition; 2002:569-626.
Martin D, McWhirt E, Napoli P. Colonic volvulus. The army medical center experience, 1983-1987. Am Surg. 1991;57:295-300.
Sule A, Misauno M, Opaluwa AS, Ojo E, Obekpas PO. One stage procedure in the management of acute sigmoid volvulus without colonic lavage. The Surgeon. 2007;5:268-70.
Remzi FH, Oncel M, Hull TL, Strong SA, Lavery IC, Fazio VW. Current indications for blow-hole colostomy:ileostomy procedure. A single center experience. Int J Colorectal Dis. 2003;18:361-4.
Poon RT, Law WL, Chu KW, Wong J. Emergency resection and primary anastomosis for left-sided obstructing colorectal carcinoma in the elderly. Br J Surg. 1998;85:1539-42.
Madiba TE, Thomson SR. The management of sigmoid volvulus. J R Coll Surg Edinb. 2000;45:74-80.
Grossmann EM, Longo WE, Stratton MD, Virgo KS, Johnson FE. Sigmoid volvulus in department of veterans affairs medical centers. Dis Colon Rectum. 2000;43:414-8.
Atamanalp SS, Ozturk G. Sigmoid volvulus in the elderly: outcomes of a 43-year, 453-patient experience. Surg Today. 2011;41:514-9.
Khanna AK, Kumar P, Khanna R. Sigmoid volvulus: study from a north India hospital. Dis Colon Rectum. 1999;42:1081-4.
Burrell HC, Baker DM, Wardrop P, Evans AJ. Significant plain film findings in sigmoid volvulus. Clin Radiol. 1994;49:317-9.
Slim K, Vicaut E, Panis Y, Chipponi J. Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg. 2004;91:1125-30.
Zmora O, Mahajna A, Bar-Zakai B, Rosin D, Hersko D, Shabtai M, et al. Colon and rectal surgery without mechanical bowel preparation. A randomized prospective trial. Ann Surg. 2003;237:363-7.
Fa-Si-Oen P, Roumen R, Buitenweg J, van de Velde C, van Geldere D, Putter H, et al. Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery. Dis Colon Rectum. 2005;48:1509-16.
Gurel M, Alic B, Bac B, Keles C, Akgun Y, Boylu S. Intraoperative colonic irrigation in the treatment of acute sigmoid volvulus. Br J Surg. 1989;76:957-8.
Gibney EJ. On-table lavage in the management of sigmoid volvulus: a review. West Afr J Med. 1992;11:223-5.
Smith SR, Connolly JC, Gilmore OJ. The effect of faecal loading on colonic anastomotic healing. Br J Surg. 1983;70:49-50.
Bruusgaard C. Volvulus of the sigmoid colon and its treatment. Surgery. 1947;22:466-78.
Akcan A, Akyildiz H, Artis T, Yilmaz N, Sozuer E. Feasibility of single-stage resection and primary anastomosis in patients with acute non-complicated sigmoid volvulus. Am J Surg. 2007;193:421-6.
Okello TR, Ogwang DM, Kisa P, Komagum P. Sigmoid volvulus and ileosigmoid knotting at St. Mary’s Hospital Lacor in Gulu, Uganda. East Cent Afr J Surg. 2009;14:58-64.
Nuhu A, Jah A. Acute sigmoid volvulus in a West African population. Ann Afr Med. 2010;9:86-90.
Ören D, Atamanalp SS, Aydinli B, Yildirgan MI, Basoglu M, Polat KY, et al. An algorithm for the management of sigmoid colon volvulus and the safety of primary resection: experience with 827 cases. Dis Col Rect. 2007;50(4):489-97.
De U, Ghosh S. Single stage primary anastomosis without colonic lavage for left-sided colonic obstruction due to acute sigmoid volvulus: a prospective study of one hundred and ninety-seven cases. ANZ J Surg. 2003;73:390-2.
