August 29, 2012 — Early elective surgery for sigmoid volvulus should be encouraged because it is associated with lower morbidity and mortality, as well as a lower incidence of recurrence, than conservative treatment, according to the findings of a retrospective study.
Omid Yassaie, MBChB, from Tauranga Hospital in New Zealand, and colleagues presented their findings in an article published online August 24 in the ANZ Journal of Surgery.
The authors remark that the optimal treatment of sigmoid volvulus and the long-term prognosis of patients after treatment are unclear. "Sigmoidoscopic treatment has gained favour as it is less invasive than surgery; however, a significant portion of patients return with recurrent volvulus," the authors write. "There is little, if any data in New Zealand or Australia on long-term follow-up of sigmoid volvulus."
The authors analyzed 57 patients (from a total of 84 admissions for sigmoid volvulus) who were admitted to the Department of General Surgery at Dunedin Hospital in New Zealand between January 1989 and January 2009 by searching the Otago Clinical Audit prospective database. Men made up 65% of the study population and 93% were of European descent.
Among these patients, 31 patients (55%) were treated conservatively (sigmoidoscopic decompression with or without rectal tube placement), whereas 26 (45%) patients were treated surgically (sigmoidoscopic decompression followed by acute sigmoid colectomy and primary anastomosis). Nineteen of the patients treated conservatively had a recurrence within a median of 31 days, whereas no patients who underwent surgery had a recurrence.
Among the 19 patients who exhibited a recurrence and required readmission, 7 patients underwent surgery and 12 received conservative treatment. No recurrence occurred among patients who underwent surgery, whereas 5 of the 12 (42%) patients who received consecutive treatment had a recurrence after a median of 4.8 months.
The complications of surgery were generally minor and included ileus (n = 1) and respiratory infection (n = 2). Although there were no cases of in-hospital mortality related to sigmoid volvulus during the study period, long-term mortality was slightly but insignificantly better in patients who underwent surgery (P = .11).
The limitations of the study included its retrospective design and the lack of control for patients lost to follow-up (eg, by moving to another area and receiving follow-up for recurrence in another hospital). The authors suspect that that latter limitation is unlikely, given the age (median age at time of first admission was 68 years) and comorbidities of the population.
The authors note that although no conclusions could be drawn regarding the best management option for patients with sigmoid volvulus and other comorbidities, the findings did illustrate the safety and efficacy of surgical management. "The study adds weight to the mounting evidence for early elective surgery on first presentation in fit patients with sigmoid volvulus," they write. "Our study demonstrates that elective surgery can be performed with low morbidity and mortality even after multiple recurrences on those patients initially treated conservatively on their index admission."
The authors have disclosed no relevant financial relationships.
Comments
Post a Comment