Sigmoid volvulus: long-term surgical outcomes and review of the literature.

OBJECTIVE: Little has been published regarding long-term surgical outcome after the initial management of acute sigmoid colon volvulus. METHODS: Patients undergoing primary resection and anastomosis (PRA) or Hartmann's procedure (HP) for sigmoid volvulus between September 1992 and August 2000 were reviewed. Eligible patients who had had the initial procedure at least 5 years previously were contacted and completed a questionnaire regarding recurrence, current symptoms and bowel habits. RESULTS: Data on 42 PRA patients and 36 HP patients were analysed. Follow-up (mean 7.2 years, range 5 - 11 years) was completed for 63 patients (37 PRA, 26 HP). Restoration of bowel continuity was successfully performed in 25 of 26 HP patients. No patient had megacolon. Constipation was reported by 83% of PRA and 65% of HP patients. Of these patients, 51% regularly used laxatives. No patient complained of incontinence, and no recurrences of sigmoid volvulus were recorded during the follow-up period. CONCLUSION: Sigmoidectomy with primary anastomosis is a good option for the definitive management of sigmoid volvulus. Despite the high constipation rate, no recurrence occurred during long-term follow-up.

Do we still need to restrict preoperative fluid administration in ambulatory anorectal surgery under spinal anaesthesia?

BACKGROUND: This study was undertaken to determine the effect of a restricted versus a standard intravenous fluid regimen on urinary retention and readiness for discharge after surgery for benign anorectal disease. METHODS: A total of 41 ASA I-II patients were randomized into a standard fluid regimen group (group S, n=21) or a restricted fluid regimen group (group R, n=20). Spinal anaesthesia was performed with hyperbaric ropivacaine. Haemodynamic variables were noted. Hypotension, headache, analgesia requirement, nausea and vomiting, thirst and urinary retention were evaluated postoperatively. The Mann-Whitney U and chi-squared tests were used. RESULTS: Patient demographics were comparable between the groups. The area under heart rate versus time curve was higher in group R than in group S (p=0.002). Additional fluid and ephedrine requirements were similar between the groups. First voiding time was longer in group R (p=0.045). CONCLUSION: In minor anorectal surgery under spinal anaesthesia with ropivacaine, standard fluid regimen provides stable haemodynamic variables without urinary retention.