SP2.10 Sigmoid Volvulus: is there any role of trephine colectomy, A Cohort Study?

Aims Sigmoid-volvulus (SV) is t3rd commonest cause of large bowel obstruction (LBO) with incidence of <10 %, recurrence rate of <80% & mortality-rate of <50%. Endoscopic decompression is indicated in uncomplicated cases, whilst surgery is indicated in complicated (failed-detorsion) & recurrent cases which usually implies a laparotomy. Aim of study is to assess sigmoid-colectomy in a single-centre in emergency-SV. Methods Cohort study of emergency sigmoid colectomy in SV was carried out from Jan’2014 to Jan’2025. Right hemicolectomy in caecal-volvulus (CV), and other emergency-laparotomy-NELA cases were recruited as controls. Results SV-resection(n=19) CV-resection(n=37) NELA(n=886) Kruskal-Wallisp-value Age(yrs) 77.8±2.1 68.8±2.6 67.6±0.5 <0.05 Sex(M:F) 11:8 8:29 414:472 <0.05 ASA 3 2 3 NS BMI(kg/m2) 24.1±1.3 23.2±0.8 25.8±0.2 <0.05 Op-time(mins) 136.6±14.4 109.2±6.9 122.3±2.2 NS ITU-stay(n) 9 16 328 NS LOS(days) 20 ± 10 10 ± 6 12 ± 7.5 <0.05 90-D-deaths(n) 2 3 114 NS Lactate(mmol/L) 2.0 ± 0.7 1.9 ± 0.2 2.1 ± 0.1 NS WCC(x109/L) 8.4 ± 1.0 12.1 ± 0.8 12.5 ± 0.2 <0.01 CRP(mg/L) 18.8 ± 6.7 48.8 ± 13.7 79.4 ± 3.5 <0.0005 PP-mortality-score 5.8 ± 1.5 7.0 ± 1.4 8.3 ± 0.5 NS Survival Rate (%) Logrank 1styear 89.5 85.8 80.9 p=NS 5thyear 26.5 70.7 61.7 10thyear 26.5 56.6 48.2 Conclusion Following SV-decompression, recurrence is high despite optimal medical management (regular enemas & laxatives). Unfortunately, patients with SV are usually elderly, frail (Rockford-Fraility-Score > 5), restricted mobility with multiple comorbidities (restrictive disease ASA 3). Apart from laparotomy, trephine sigmoid colectomy (resection ± anastomosis) is a shorter operation which could reduce impact of laparotomy & potentially aid recovery in high-risk patient.