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Introduction:
Natural orifice specimen extraction is the next step in minimally invasive colorectal surgery but can be technically challenging with additional risks especially for oncologic surgery. For several key reasons, sigmoid volvulus is well suited for natural orifice specimen extraction surgery. We describe our method and experience with d...
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Context 1
... patient is put in the modified Lloyd-Davis position. A 4-port laparoscopic technique is used; an optical port at the umbilicus, one 12-mm port at the right iliac fossa, one 5-mm port at the right flank, and another 5-mm port at the left iliac fossa (Fig. 1). The abdominal cavity is insufflated to a pressure of 12 mm Hg, and the patient is placed in the Trendelenburg position with the left side elevated. An operative video (see Video at http://links.lww. com/DCR/B485) demonstrates the procedure described in the following ...
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Background
Sigmoid volvulus represents a torsion of the sigmoid colon on its mesenteric axis leading to large bowel obstruction by strangulation. The best choice between the different therapeutic methods which are endoscopic treatment and/or surgery, constitutes a challenge. Our research aim was to evaluate the safety and efficacy of laparoscopy fo...
Background
Caecal volvulus (CV) is a rare cause of bowel obstruction. However, there has been a steady rise in the number of cases over the decades. The demographic profile of patients developing CV has changed to a much older population. We conducted a retrospective review to determine the incidence, demographic profile, management, and outcomes o...
Introduction
Ileo-sigmoid knotting is a very rare cause of bowel obstruction. The diagnosis can be challenging and may not be suspected pre-operatively. A high index of suspicion, especially in areas of the “sigmoid belt” region, can be helpful.
Case presentation
A 40-year-old ethnic Amhara female patient presented with symptoms and signs of bowel...
Background
In pediatric surgical practice, volvulus of the sigmoid volvulus remains a rare cause of intestinal obstruction and this diagnosis is seldom considered in children.
Case presentation
We present a 14-year old male who came with a 2-day history of abdominal pain, vomiting and abdominal distension. Plain abdominal x ray showed features of...
Introduction
and importance: Caecal volvulus represents 30% of colonic volvulus. It happens due to torsion or hyperflexion of a hypermobile caecum. Usually it is secondary to an axial rotation of the caecum and the ileum around the mesentery. On the other hand Intestinal malrotation occurs due to incomplete or faulty rotation and fixation of the gu...
Citations
... The optimum therapeutic approach for treating volvulus is still up for debate and depends on the surgery selected, the patient's clinical state, the location of the problem, the possibility or con rmation of peritonitis, the viability of the intestine, and the surgical team's experience (1). Patients should undergo urgent surgery if they have signs of intestinal perforation or ischemia when they rst arrive (4). In the absence of peritonitis, exible sigmoidoscopy, which has an 80% success rate for colonic detorsion and decompression, is the rst-line treatment of choice for sigmoid volvulus (4). ...
... Patients should undergo urgent surgery if they have signs of intestinal perforation or ischemia when they rst arrive (4). In the absence of peritonitis, exible sigmoidoscopy, which has an 80% success rate for colonic detorsion and decompression, is the rst-line treatment of choice for sigmoid volvulus (4). Elective sigmoid colectomy is the recommended course of treatment for instances of simple volvulus following detorsion. ...
Introduction
In Uganda, one of the leading causes of intestinal obstruction is sigmoid volvulus. Due to unavailability of endoscopic services in some settings, most of the patients usually undergo emergency surgery. The aim of this study was to determine the clinical profile and factors associated with early adverse outcome following surgery for sigmoid volvulus at Jinja, Hoima and Fortportal regional referral hospitals (FRRH, HRRH and FRRH respectively).
Methods
This was an observational prospective cohort done at 3 regional referral hospitals in Uganda. Patients undergoing surgery for sigmoid volvulus were enrolled consecutively and followed up till the time of discharge or death to document the mortality, occurrence of complications and length of hospital stay. Data analysis was done using SPSS version 26 with Poisson regression done to determine the factors.
Results
In this study that enrolled 81 participants, majority were males 63(77.8%) with a mean age of 55.1(SD=14.2) years. Hemodynamic instability was seen in 27(33.3%), non-viable gut in 27(33.3%) with colostomies placed in 61(75.3%) of the participants. Death occurred in 10(12.3%) of the patients, while 37(45.7%) had at least one complication with the commonest complication being surgical site infection 21(25.9%). The median length of hospital stay (LOS) was 8(IQR=7-11) days. At multivariate level of analysis, hyperkalemia (aRR=2.210, CI=1.512-3.630, P=0.024) and presence of a sigmoid perforation (aRR=1.913, CI=1.015-3.962, P<0.001) were independently associated with mortality, hypertension (aRR=2.726, CI=1.206-6.158, P=0.016) and presence of hemodynamic instability (aRR=2.500, CI=1.561-4.004, P<0.001) associated with occurrence of complications, while duration of symptoms greater than 3 days (aRR=1.217, CI=1.016-1.458, P=0.033) and hemodynamic instability (aRR=1.165, CI=1.017-1.335, P=0.028) were independently associated with prolonged hospital stay.
Conclusion
A big proportion of the participant’s presented with hemodynamic instability and non-viable gut resulting in placement of many colostomies. The mortality and morbidity were high as well as the length of hospital stay. More sensitization in relation to early presentation to hospital is still needed in order to reduce the number of patients that present with hemodynamic instability and non-viable or perforated sigmoid which in turn could improve the outcomes.
... 3,5,7,10,13,19,27,36 The mortality is 0 to 2%, the morbidity is 10 to 25%, and the recurrence is 0 to 1%. 1,3,5,10,19,24,26,36,42,43 In this field, the best innovation of the recent time is natural orifice specimen extraction with laparoscopic sigmoidectomy and primary anastomosis. [44][45][46] Percutaneous endoscopic sigmoidopexy (PES; or PE colopexy or PE colostomy [PEC]) is the fixation of the apex of the sigmoid colon to the anterior abdominal wall by using endoscopic stoma kits (►Fig. 1F). ...
Sigmoid volvulus (SV) is a rare form of intestinal obstruction in which the sigmoid colon twists around its own base. Endoscopic detorsion is the primary treatment in uncomplicated patients, while urgent surgery is required in the cases with bowel perforation, peritonitis, and unsuccessful endoscopic detorsion. In surgery, the gangrenous sigmoid colon is managed by resection, whereas sigmoid detorsion alone or with an additional recurrence-reducing procedure is applied in patients with viable bowel. However, the risk of recurrence following endoscopic or operative detorsion alone is as high as 90% with a risk of mortality up to 35%. To prevent or reduce SV recurrence, some selected cases require emergent or elective recurrence-preventive management including sigmoidopexy, mesopexy, mesoplasty, extraperitonealization, sigmoidectomy, and endoscopic percutaneous sigmoidopexy. However, the indications, techniques, and results of the above-mentioned procedures are controversial. In this review, the treatment options of SV and patient selection criteria for recurrence-preventive treatments are discussed.
... Natural orifice specimen extraction is commonly used in colorectal cancer surgery. However, laparoscopic sigmoidectomy for uncomplicated sigmoid volvulus has been proposed as an ideal condition for transanal NOSE because there is no physical mass and only close colonic dissection is required, thus ensuring the ease of specimen retrieval [5]. In Video S1 we present a detailed step-by-step approach to elective laparoscopic sigmoidectomy with transanal NOSE in a 66-year-old woman (body mass index 18.0 kg/m 2 ) with recurrent sigmoid volvulus. ...
Natural orifice specimen extraction (NOSE) is an alternative to transabdominal specimen retrieval in laparoscopic colorectal surgery. The reduced wound size with NOSE decreases postoperative pain, allows quicker recovery and provides better cosmesis [1-3]. A specimen size cutoff for NOSE in colorectal surgery is recommended by international consensus guidelines to achieve successful extraction [4]. Natural orifice specimen extraction is commonly used in col-orectal cancer surgery. However, laparoscopic sigmoidectomy for uncomplicated sigmoid volvulus has been proposed as an ideal condition for transanal NOSE because there is no physical mass and only close colonic dissection is required, thus ensuring the ease of specimen retrieval [5]. In Video S1 we present a detailed step-by-step approach to elective laparoscopic sigmoidectomy with transanal NOSE in a 66-year-old woman (body mass index 18.0 kg/m 2) with recurrent sigmoid volvulus. Mechanical bowel preparation was administered. A 12-mm transumbilical camera port was used, with 12-mm and 5-mm right-sided ports. The patient was discharged within 24 h of surgery. While the previous technical description involves exteriorization of the proximal colon via the anus to secure the circular stapler anvil [5], we advocate a simple alternative in NOSE surgery for volvulus, in which the circular anvil is secured intracoporeally. This modification allows sigmoid dissection to be performed to a more proximal location, which reduces post-anastomosis bowel redundancy. This may decrease the risk of recurrent volvulus after sigmoid resection reported in other series [6, 7]. Considering its simplicity and potential benefits, the NOSE procedure should be considered in sigmoid colectomy for uncomplicated volvulus. Good bowel preparation is mandatory for this procedure to minimize the risk of luminal content spillage. AUTH O R CO NTR I B UTI O N S
... October 24, 2022 Volume 13 Issue 10 The hypothetical advantage of rectal purse-string closure is the creation of a double purse-string single-stapled anastomosis ( Figure 4). This method eliminates the "dog-ears" of the anastomosis, with theoretical points of weakness at the corners of the linear staple line and the cross-stapled junctions between the linear and circular staple lines [16]. Furthermore, the double purse-string anastomosis enabled the use of a smaller 5 mm port instead of 12 mm, as a linear stapler was not required (Figure 1). ...
Background:
Natural orifice specimen extraction (NOSE) via the anus or vagina replaces conventional transabdominal specimen retrieval via the transabdominal route through a limited mid-line laparotomy or Pfannenstiel incision. Reducing the number of laparoscopic ports further decreases operative abdominal wall trauma. These techniques reduce the surgical wound size as well as the risk of incision-related morbidity.
Aim:
To compare short-term outcomes following 3-port NOSE surgery with a matched cohort of conventional non-NOSE colorectal cancer surgery.
Methods:
Patients who underwent elective 3-port laparoscopic colorectal NOSE surgery between February to October 2021 were identified. Selection criteria for NOSE surgery was adapted from the 2019 International Consensus on Natural Orifice Specimen Extraction Surgery for colorectal cancer. Patients with clinical T4 or N2 tumors on staging computed tomography were also excluded. The propensity score-matched cohort was identified amongst patients who underwent conventional laparoscopic colorectal surgery from January 2019 to December 2020. Matching was performed in the ratio of 1:4 based on age, gender, type of resection, and p - tumor node metastasis staging.
Results:
Over the eight-month study duration, 14 consecutive cases (nine female, five male) of elective 3-port laparoscopic surgery with NOSE were performed for colorectal cancer. Median age and body mass index were 70 (range 43-82) years and 24.1 (range 20.0-31.7) kg/m2 respectively. Six patients underwent transanal NOSE and eight had transvaginal NOSE. Median operative time, intraoperative blood loss and postoperative length of stay were 208 (range 165-365) min, 30 (range 10-150) mL and 3 (range 2-6) d respectively. Two (14%) suffered minor postoperative compilations not attributable to the NOSE procedure. Median follow-up duration was 12 (range 8-15) mo. No instances of mortality, local or distant disease recurrence were recorded in this cohort. Compared to the conventional surgery cohort of 56 patients, the 3-port NOSE cohort had significantly quicker mean return of bowel function (2.6 vs 1.2 d, P < 0.001), reduced postoperative pain and patient-controlled analgesia use, and decreased length of hospital stay (6.4 vs 3.4 d, P < 0.001). There were no statistical differences in surgical duration and perioperative complication rates between the NOSE and non-NOSE cohorts.
Conclusion:
3-port laparoscopic colorectal surgery with NOSE is a feasible technique, augmenting the minimally invasive nature of surgery and producing good outcomes. Appropriate patient selection and expertise in conventional laparoscopy are required.
... Five were national analysis [25 −29], 1 a case-match analysis [7] and 1 a comparative study [30]. For 2 articles, the type of study was not specified [31,32]. ...
... The PRISMA flowchart and the search process is detailed at Fig. 1. Two studies were considered as good quality [18,19];17 as moderate quality [7,8,[13][14][15]17,[20][21][22][23][25][26][27][28][29][30]32] and 3 as low quality [16,24,31]. ...
... Totally, 8 studies were considered with serious risk of bias [7,13,17,22,24,26,28,29]; 5 with moderate risk [14][15][16]23,30] and 4 studies with low risk of bias [8,18−20]. For 5 studies, we did not have enough information to assess the risk of bias (only abstracts available) [21,25,27,31,32]. ...
Background
Sigmoid volvulus represents a torsion of the sigmoid colon on its mesenteric axis leading to large bowel obstruction by strangulation. The best choice between the different therapeutic methods which are endoscopic treatment and/or surgery, constitutes a challenge. Our research aim was to evaluate the safety and efficacy of laparoscopy for the management of sigmoid volvulus.
Methods
We performed a systematic review to determine the safety and efficacy of laparoscopy for sigmoid volvulus. We collected all the published data between January 1980 and November 2020. A meta-analysis compared the odds ratio (OR) with the 95% confidence interval (CI) of complications between open and laparoscopic approach for sigmoid volvulus.
Results
Totally, 22 articles were included. Most of the studies were from high income countries. The total number of patients in the studies was 30,810 with 29,874 cases of sigmoid volvulus. Among these cases, 2089 were managed with laparoscopic surgery (7%). The most frequent intervention for sigmoid volvulus was resection and anastomosis in 96.5% (n = 2016/2089) and the main indication was uncomplicated sigmoid volvulus after endoscopic detorsion in 97.9% (n = 793/810). The meta-analysis showed that patients with sigmoid volvulus operated by laparoscopy had a lower risk of complications compared to those with open approach (OR=0,49;p = 0,001).
Conclusion
This systematic review found a low rate of post-operative complications after laparoscopic for sigmoid volvulus. It suggests the safety and efficacy of laparoscopy for sigmoid volvulus. However, further studies (randomised controlled trials) are needed to establish the real benefits of laparoscopy for sigmoid volvulus.
... 3 Our results related to the surgical treatment are compatible with the literature findings. On the other hand, in patients with successful non-operative decompression, to prevent a VR, elective sigmoid resection is suggested in nonelderly and well-conditioned patients, 3,9 which procedure did any good in our series. As an alternative, Percutaneous Endoscopic Colopexy (PEC) may be used in elderly or bad-conditioned patients for the same purposes. ...
... To prevent the VR, elective sigmoid colectomy with primary anastomosis, preferably by using laparoscopy, is recommended in selected patients. 9 However, the selection criteria are not objectively identified in literature. 6,7,9,10 In our opinion and experience, elective surgery may be suggested in patients under 70-75 years old and with American Society of Anesthesiologists (ASA) classes 1-3, whose estimated operative mortality rates are less than 4.3%. ...
... 9 However, the selection criteria are not objectively identified in literature. 6,7,9,10 In our opinion and experience, elective surgery may be suggested in patients under 70-75 years old and with American Society of Anesthesiologists (ASA) classes 1-3, whose estimated operative mortality rates are less than 4.3%. On the other hand, PEC, preferably as an elective procedure, may be tried in patients over 75 years old or with ASA class ≥4 patients, whose estimated operative mortality rates are higher than 7.8%. ...
Sigmoid Volvulus (SV) is principally treated with non-operative decompression, whereas it may require surgical management in some situations. Depending upon the treatment method, SV recurs in about one fourth of the cases, which doubles the mortality and morbidity rates. In this paper, we discuss the management and related recurrence of SV in the light of the largest single-center SV series over the world.
Hernia remains a challenge for the colorectal surgeon both in regard to prevention of hernia, that is a common entity following colorectal surgery and in managing hernia which is often made more challenging by the co-existence of a significant colorectal-specific problem. This review outlines the extent of hernia as a problem for the colorectal surgeon and highlights contemporary approaches to dealing with patients who require both colorectal and complex hernia surgery.
