Comparison of two surgical techniques for resection of uncomplicated sigmoid volvulus: laparoscopy or open surgical approach?

AIM OF THE STUDY: The optimal treatment for acute sigmoid volvulus has not been defined. Our aim was to compare the results of two techniques for the management of uncomplicated sigmoid volvulus coming from two separate surgical services, which had each chosen a different technique: open surgical versus laparoscopic. PATIENTS AND METHODS: Patients with sigmoid volvulus who underwent a surgical resection with immediate anastomosis, either emergency or scheduled, were included. Risk of morbidity (Dindo-Clavien criteria) and mortality (criteria of the AFC-French Association of Surgery) were evaluated. RESULTS: Thirteen patients in the open surgical group were operated in a 10-year period and 17 patients in the laparoscopy group were operated on in a seven-year period. The mean age (57 years in both groups) and sex ratio (0.7 versus 0.6, respectively), and the length of hospital stay (18 versus 15 days, respectively) were comparable in the two groups. The open surgical procedure was performed urgently in 62% (n=8/13) versus 24% (n=4/17) in the laparoscopic group. The two groups were comparable in terms of risk factors for mortality by AFC score. The anastomotic leak rate was 8% (n=1/13) for the open surgical group versus 18% (n=3/17) for the laparoscopic group, while serious morbidity was 15% (n=2/13) versus 12% (n=2/17). No recurrence of volvulus was observed in the open group (mean follow-up of 26 months) versus 12% (n=2) in the laparoscopy group (mean follow-up of 32 months). CONCLUSION: We did not find any significant difference between the two techniques. But the technical simplicity and the absence of recurrence in the open surgical group emphasize the importance of this technique.