Management of viable sigmoid volvulus by mesosigmoidoplasty

ABSTRACT

Mesosigmoidoplasty is a non-resective procedure for viable sigmoid volvulus. It corrects the main pathogenetic factor, the narrow but long mesosigmoid. This study was conducted to know the outcome of mesosigmoidoplasty in cases of viable sigmoid volvulus. This prospective study was conducted from July 2004 to June 2008 at District Headquarter Teaching Hospital D.I.Khan, on patients admitted with large gut obstruction due to viable sigmoid volvulus. After initial investigations and resuscitation, non-operative decompression was tried in all cases. Successfully decompressed patients underwent elective laparotomy and the rest had emergency laparotomy and mesosigmoidoplasty. After their discharge from hospital, patients were followed up for 6 months. Thirty-nine patients presented with viable sigmoid volvulus; 35 males and 4 females, with male to female ratio of 8.71. Age range was 48-70 years. Thirteen [33%] patients had successful decompression. Two patients refused surgery after successful non-operative decompression and were dropped from the study. Out of the remaining 37 patients 11[30%] patients had mesosigmoidoplasty on elective list and 26[70%] had emergency operation for mesosigmoidoplasty. Average hospital stay was 4 days [2-6 days]. Post-operative complications were wound infection in 1[2.7%] and paralytic ileus in 3[8%] cases. During 6 months follow-up, only 1[2.7%] patient had recurrence. Mesosigmoidoplasty is a definitive procedure for viable sigmoid volvulus with low rates of mortality, morbidity