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Awedew AF, Asefa Z, Enkoye BD. Comparing Resection and Primary Anastomosis versus Hartmann's Stoma on the Mortality and Morbidity of Gangrenous Sigmoid Volvulus: Systematic Review and Meta-Analysis. Ethiop J Health Sci 2023; 33:1087-1096. [PMID: 38784481 PMCID: PMC11111268 DOI: 10.4314/ejhs.v33i6.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/31/2023] [Indexed: 05/25/2024] Open
Abstract
Background Gangrenous sigmoid volvulus has a significant impact on morbidity and mortality. This study was conducted to compare sigmoid resection and primary anastomosis (RPA) with sigmoid resection and end colostomy (Hartmann's procedure) for gangrenous sigmoid volvulus. Methods A systematic review and meta-analysis study design was employed to summarize retrospective cohort, prospective cohort, and randomised control trial studies published from inception to march 31, 2023. Searching was performed on Medline, CINAHAL, Web of Science, Google Scholar, the Cochrane Library, and ClinicalTrials.gov to locate eligible articles. Data searching, selection and screening, quality assessment of the included articles, and data extraction were done by two separate reviewers. RevMan 5.4 software with a fixed-effect Mantel-Haenszel model and Stata version 14 were used to analyze the data. The protocol registered on PROSPERO registration website (CRD42023413367). Results Ten cohort studies and one randomised control trial with 724 patients were found; all of them were rated as being of moderate quality. The overall mortality after RPA was 15% (95%CI: 11-19%), and after Hartmann's procedure it was 19% (95%CI: 15-23%). Resection and primary anastomosis (RPA) for gangrenous sigmoid volvulus had slightly lower mortality rate than stoma (OR=0.98(95%CI: 0.68-1.42), p=0.07, I2=43%), which had no statistically significant difference. Resection and primary anastomosis (RPA) had a slightly higher morbidity rate than Hartmann's procedure (OR=1.01(95%CI: 0.66-1.55), p=0.30, I2=18%), which had no statistically significant difference. Conclusion Sigmoid resection and primary anastomosis (RPA) and Hartmann's procedure had no significant differences in mortality and morbidity for the treatment of gangrenous sigmoid volvulus. Choice of the intervention for gangrenous sigmoid volvulus should be individualized with consideration of different detrimental factors.
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Affiliation(s)
| | - Zelalem Asefa
- Department of surgery, Addis Ababa University, Ethiopia
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Uylas U, Kayaalp C. Different clinicopathological features of non-elderly sigmoid volvulus patients. Int J Colorectal Dis 2020; 35:1937-1942. [PMID: 32661782 DOI: 10.1007/s00384-020-03689-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Sigmoid volvulus is frequently seen in male patients over 60 years old. Here, we aimed to investigate the causes of sigmoid volvulus developing in patients under 60 years of age. METHODS Patients diagnosed with sigmoid volvulus between 2009 and 2018 were retrospectively analyzed. The patients were divided into two as under 60 years old and above. The co-morbidity, mortality, morbidity, complications, age, and gender data were analyzed. RESULTS A total of 134 patients were included. The median age was 70 (19-92), ≤ 59 age patients constituted 24% of all patients. Eighty-one percent (109/134) of the patients were male, and male/female ratio was lower in ≤ 59 age patients (2.0 vs 6.2, p = 0.01). Diseases that caused and underlying colon dilatation (mental retardation with hypomotility, pregnancy-puerperium, Hirschsprung's disease, etc.) were more common in ≤ 59 age patients, but no observed at 60≤ age patients (15.2% vs 0%, p = 0.0007). While there was no difference between the two groups in terms of mortality, it was proportionally higher in the 60≤ age group (3.0% vs. 13.9%, p = 0.12). CONCLUSION By decreasing age, male dominance disappears progressively, and it is likely to have an underlying colonic hypomotility in young sigmoid volvulus patients.
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Affiliation(s)
- Ufuk Uylas
- Faculty of Medicine, Gastroenterology Surgery, Inonu University, Malatya, Turkey.
| | - Cuneyt Kayaalp
- Faculty of Medicine, Gastroenterology Surgery, Inonu University, Malatya, Turkey
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Endoscopic Detorsion Results in Sigmoid Volvulus: Single-Center Experience. Emerg Med Int 2020; 2020:1473580. [PMID: 32455020 PMCID: PMC7243014 DOI: 10.1155/2020/1473580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/24/2020] [Indexed: 02/07/2023] Open
Abstract
Endoscopic detorsion is the first-line recommended treatment modality in sigmoid volvulus patients who have no peritoneal irritation signs on admission. In this paper, we present the results of endoscopic detorsion procedures applied at the time of presentation with the diagnosis of sigmoid volvulus and review the current literature about this topic.
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Abstract
Sigmoid volvulus (SV) is the wrapping of the sigmoid colon around its mesentery, and sigmoid gangrene is a catastrophic complication of SV. Although the diagnosis of SV is generally not difficult, unfortunately, most of the clinical, laboratory and radiological signs are not pathognomonic in demonstrating sigmoid gangrene. The treatment of gangrenous SV requires emergency surgery. Sigmoid gangrene worsens the prognosis of SV by doubling the mortality rate.
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Affiliation(s)
- Sabri Selcuk Atamanalp
- Prof. Sabri Selcuk Atamanalp, MD. Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Esra Disci
- Esra Disci, MD. Assistant Professor, Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Refik Selim Atamanalp
- Refik Selim Atamanalp, MD. Assistant Professor, Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Abstract
Intestinal volvulus, regardless of location, is a rare disease process, but one that requires high suspicion and timely diagnosis given the increased incidence of intestinal necrosis and potential mortality. Most patients with intestinal volvulus require some form of surgical intervention. However, over the last few decades, the work-up and management of intestinal volvulus has changed given constant advancements in technology and patient care. Most importantly, however, is recognizing the need for emergent versus more elective surgery because this influences the morbidity and mortality for the individual patient.
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Affiliation(s)
- Zachary M Bauman
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of General Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA.
| | - Charity H Evans
- Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of General Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA
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Atamanalp SS. Comments on clinical outcomes of sigmoid colon volvulus: identification of the factors associated with successful endoscopic detorsion. Intest Res 2017; 15:552-553. [PMID: 29142529 PMCID: PMC5683992 DOI: 10.5217/ir.2017.15.4.552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 08/28/2017] [Accepted: 08/28/2017] [Indexed: 11/13/2022] Open
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Atamanalp SS, Atamanalp RS. What is done when endoscopic examination reveals borderline bowel ischemia in patients with sigmoid volvulus? Pak J Med Sci 2017; 33:761-763. [PMID: 28811810 PMCID: PMC5510142 DOI: 10.12669/pjms.333.12265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Sigmoid volvulus (SV) is a rare colonic obstruction in which the sigmoid colonwraps around itself. The principal strategy for the treatment of uncomplicated SV is emergency endoscopic detorsion, while emergency surgery is needed in complicated SV with bowel gangrene, bowel perforation, peritonitis, or unsuccessful endoscopic treatment. In the endoscopic examination of SV, endoscopic detorsion is performed if the bowels are viable, while emergency surgery is needed if the bowels are gangrenous. However, the treatment approach is not clear when endoscopic examination reveals borderline bowel ischemia, and in this short report, the possible treatment strategies are discussed.
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Affiliation(s)
- Sabri Selcuk Atamanalp
- Prof. Sabri Selcuk Atamanalp, MD. Department of General Surgery Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Refik Selim Atamanalp
- Refik Selim Atamanalp, English Medicine Program, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Iida T, Kaneto H, Nakase H. Author's Reply. Intest Res 2017; 15:554. [PMID: 29142530 PMCID: PMC5683993 DOI: 10.5217/ir.2017.15.4.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 09/15/2017] [Accepted: 09/15/2017] [Indexed: 12/04/2022] Open
Affiliation(s)
- Tomoya Iida
- Department of Gastroenterology, Muroran City General Hospital, Muroran, Japan
| | - Hiroyuki Kaneto
- Department of Gastroenterology, Muroran City General Hospital, Muroran, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Abstract
Colonic volvulus is the third leading cause of colonic obstruction worldwide, occurring at two principal locations: the sigmoid colon and cecum. In Western countries, sigmoid volvulus preferentially affects elderly men whereas cecal volvulus affects younger women. Some risk factors, such as chronic constipation, high-fiber diet, frequent use of laxatives, personal past history of laparotomy and anatomic predispositions, are common to both locations. Clinical symptomatology is non-specific, including a combination of abdominal pain, gaseous distention, and bowel obstruction. Abdominopelvic computerized tomography is currently the gold standard examination, allowing positive diagnosis as well as detection of complications. Specific management depends on the location, patient comorbidities and colonic wall viability, but treatment is an emergency in every case. If clinical or radiological signs of gravity are present, emergency surgery is mandatory, but is associated with high morbidity and mortality rates. For sigmoid volvulus without criteria of gravity, the ideal strategy is an endoscopic detorsion procedure followed, within 2 to 5 days, by surgery that includes a sigmoid colectomy with primary anastomosis. Exclusively endoscopic therapy must be reserved for patients who are at excessive risk for surgical intervention. In cecal volvulus, endoscopy has no role and surgery is the rule.
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Affiliation(s)
- L Perrot
- Service de chirurgie viscérale et digestive, centre hospitalier régional et universitaire, avenue de la Côte-de-Nacre, 14000 Caen, France.
| | - A Fohlen
- Service de radiologie, centre hospitalier régional et universitaire, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - A Alves
- Service de chirurgie viscérale et digestive, centre hospitalier régional et universitaire, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - J Lubrano
- Service de chirurgie viscérale et digestive, centre hospitalier régional et universitaire, avenue de la Côte-de-Nacre, 14000 Caen, France
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Atamanalp SS, Atamanalp RS. The role of sigmoidoscopy in thediagnosis and treatment of sigmoid volvulus. Pak J Med Sci 2016; 32:244-8. [PMID: 27022384 PMCID: PMC4795878 DOI: 10.12669/pjms.321.8410] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Sigmoid volvulus (SV) is a rare form of acute intestinal obstruction in which the sigmoid colon wraps around itself. The disease generally presents as a mechanical bowel obstruction with clinical features that are not pathognomonic. Similarly, X-ray films are not diagnostic in most cases. It is difficult to establish the correct preoperative diagnosis when CT and MRI are not used. The principal strategy in the treatment of SV in uncomplicated patients is emergency endoscopic detorsion followed by elective surgery; emergent surgery is required in patients with bowel gangrene, bowel perforation, peritonitis, or unsuccessful endoscopic treatment. In this review, we have discussed the role of sigmoidoscopy in the diagnosis and treatment of SV. Additionally, we have retrospectively and prospectively evaluated our 49-year, 987-patient clinical experience, the largest single-center SV series ever reported.
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Affiliation(s)
- Sabri Selcuk Atamanalp
- Prof. Sabri Selcuk Atamanalp, MD, Department of General Surgery, Faculty of Medicine, Ataturk University, 25040, Erzurum, Turkey
| | - Refik Selim Atamanalp
- Refik Selim Atamanalp, English Medicine Program, Faculty of Medicine, Ataturk University, 25040, Erzurum, Turkey
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