Novel Approach to Treat Uncomplicated Sigmoid Volvulus Combining Minimally Invasive Surgery with Enhanced Recovery, in a Rural Hospital in Zambia

• Published in: World journal of surgery 2018-06, Vol.42 (6), p.1590-1596
• Main Authors: van der Naald, Niels, Prins, Marloes I., Otten, Kars, Kumwenda, Dayson, Bleichrodt, Robert P.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adolescent; Adult; Aged; Aged, 80 and over; Anastomosis; Anastomosis, Surgical; Bladder; Cardiac Surgery; Clinical Protocols; Colon, Sigmoid - surgery; Complications; Decompression; Dehiscence; Female; General Surgery; Hematuria; HIV; Hospitals, Rural - statistics & numerical data; Human immunodeficiency virus; Humans; Intestinal Volvulus - epidemiology; Intestinal Volvulus - surgery; Intestine; Laparotomy; Male; Medical instruments; Medicine; Medicine & Public Health; Middle Aged; Minimally invasive surgery; Minimally Invasive Surgical Procedures; Morbidity; Mortality; Original Scientific Report with Video; Patients; Perioperative Care; Recovery; Retrospective Studies; Sepsis; Sigmoid Diseases - epidemiology; Sigmoid Diseases - surgery; Surgery; Thoracic Surgery; Time Factors; Urinary bladder; Vascular Surgery; Young Adult; Zambia - epidemiology
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-017-4405-9

Aim In sub-Saharan Africa, sigmoid volvulus is a frequent cause of bowel obstruction. The aim of this study was to evaluate the results of acute sigmoid resection and anastomosis via a mini-laparotomy in patients with uncomplicated sigmoid volvulus, following the principles of “Enhanced Recovery After Surgery (ERAS)”, in a low-resource setting. Materials and methods Patients with uncomplicated sigmoid volvulus were operated acutely, via a mini-laparotomy, according to the principles of ERAS. Intraoperative complications, duration of operation, morbidity, mortality and length of hospital stay were evaluated, retrospectively. Results From 1 March 2012 to 1 September 2017, 31 consecutive patients were treated with acute sigmoid resection and anastomosis, via a mini-laparotomy. There were 29 men and 2 women, median age 57 (range 17–92) years. Patients were operated after a median period of 4 (range 1.5–18) hours. The median duration of the operative procedure was 50 (range 30–105) minutes. Two patients died (6.3%). One patient died during an uncomplicated operation. The cause of death is unknown. One patient with a newly diagnosed HIV infection had an anastomotic dehiscence. After Hartmann’s procedure, he died on the 17th post-operative day as a result of a HIV-related double-sided pneumonia, without signs of abdominal sepsis. One patient had an urinary retention and 1 patient haematuria after bladder catheter insertion. Conclusion Acute sigmoid resection and primary anastomosis via a mini-laparotomy for uncomplicated sigmoid volvulus, without preoperative endoscopic decompression is a safe procedure with a low morbidity and mortality.