Minimal access surgery for sigmoid volvulus in children

Is Laparoscopy Underutilized for Sigmoid Volvulus?

PURPOSE

Minimally invasive surgery has become increasingly prevalent. However, the majority of colectomies for volvulus are still performed via an open technique. The purpose of this study is to determine whether there is a difference in outcomes between laparoscopic and open procedures for sigmoid volvulus.

MATERIALS AND METHODS

The American College of Surgeons National Surgical Quality Improvement Program and colectomy-targeted procedure databases were queried from 2013 to 2018. Patients undergoing partial colectomy without ileal resection for the indication of volvulus were compared based on approach (planned laparoscopic vs. planned open). The 2 groups were propensity score matched for perioperative variables. A subgroup analysis was performed comparing unplanned laparoscopic conversion to open (CTO) with planned open procedures. The primary outcomes were overall morbidity, mortality, and length of stay.

RESULTS

Total 2493 patients were identified. Four hundred ninety-two cases began laparoscopically (20%), of which 391 were completed laparoscopically (79%). Laparoscopic approach was associated with longer operative times (133 vs. 104 min, P<0.001). Laparoscopic approach was associated with decreased overall morbidity (OR: 0.71, 95% CI, 0.54 to 0.93) and decreased length of stay when >7 days (OR: 0.70, 95% CI, 0.52 to 0.94). On subgroup analysis, there was no difference in outcomes when comparing unplanned CTO to planned open approach.

CONCLUSIONS

Laparoscopic approach is used in a fraction of cases for colonic volvulus. When utilized, the majority are completed without CTO. Laparoscopy is associated with fewer complications and shorter hospital stays. Even with unplanned conversion to open, there is no difference in outcomes compared against planned open procedures. Surgeons should consider the utilization of laparoscopy for colonic volvulus.

Volvulus of sigmoid colon in a challenged adolescent: An unusual case report

Sigmoid volvulus is very uncommon cause of intestinal obstruction in pediatrics population withhigh rate of mortality. To date, few cases of sigmoid volvulus in children and association with several condition has been reported in literature, of them very few cases are with mental disability. We report a challenged (mentally disabled) 14-year old adolescent boy presented asan emergency with feature of complete bowel obstruction. Abdominal X-rays shows dilated loop of large bowel with inverted U shaped. Volvulus of sigmoid colon was found during laparotomy and successfully managed with resection of a redundant colon with colocolic end to end anastomosis. Sigmoid volvulus is relatively uncommon in children as compared to adults. Surgeons should be attentive of this rare entity, cause of large bowel obstruction to allow for early diagnosis and to enable better patient outcomes by reducing the morbidity and mortality.

Single-port laparoscopic surgery for sigmoid volvulus

AIM: To report our experience with single-port laparoscopic surgery (SPLS) for sigmoid volvulus (SV).

METHODS: Between October 2009 and April 2013, 10 patients underwent SPLS for SV. SPLS was performed transumbilically or through a predetermined stoma site. Conventional straight and rigid-type laparoscopic instruments were used. After intracorporeal, segmental resection of the affected sigmoid colon, the specimen was extracted through the single-incision site. Patient demographics and perioperative data were analyzed.

RESULTS: SPLS for SV was successful in all 10 patients (4, resection and primary anastomosis; 6, Hartmann’s procedure). The median operative time and postoperative hospitalization period were 168 (range, 85-315) min and 6.5 (range, 4-29) d, respectively. No intraoperative complications were noted; there were 2 postoperative complications, including 1 anastomotic leak.

CONCLUSION: SPLS was a safe and feasible therapeutic approach for SV, when performed by a surgeon experienced in conventional laparoscopic surgery.

Incisionless Hartmann's procedure: an innovative minimal access technique for surgical treatment of sigmoid volvulus in debilitated patients with faecal incontinence

Sigmoid volvulus requires decompression and subsequent surgical correction, and is often seen in debilitated patients. In an effort to decrease the physiological burden of surgery in these high-risk patients, we report an innovative minimal access technique for the definitive treatment of decompressed sigmoid volvulus in patients with concomitant faecal incontinence. A retrospective chart review of a series of two consecutive patients who had undergone a minimal access Hartmann's procedure (HP) between November 2005 and October 2006 was performed. A single skin incision of < or = 4 cm at the proposed colostomy site was used to identify, exteriorize, divide, and resect the redundant mesosigmoid and sigmoid colon. The same incision was used to mature the end-colostomy. No other incisions were created, and no laparoscopy or laparoscopic instruments were used. Perioperative clinical parameters and outcomes are reported. Patient 1 was a 94-year-old male, American Society of Anesthesiologists (ASA) class 4, who underwent a HP via a 4-cm skin incision under general anaesthesia in 150 min with a length of inpatient stay of 5 days. Patient 2 was an 83-year-old female, ASA class 3, who underwent a HP via a 3-cm skin incision under conscious sedation in 83 min, with a length of inpatient stay of 4 days. Estimated blood loss was <50 cm(3) for both patients, both patients had bowel function and were tolerating oral feeds upon discharge, and there was no perioperative morbidity or mortality in either patient at 30 days. Incisionless HP appears feasible in treating sigmoid volvulus and faecal incontinence in debilitated patients.