Colonoscopy-assisted percutaneous sigmoidopexy: a novel, simple, safe, and efficient treatment for inoperable sigmoid volvulus (with videos).

Abstract

BACKGROUND AND AIMS:

Many patients with sigmoid volvulus are old with co-morbidities, making elective surgery prohibitive. Colonoscopic management is often successful but volvulus often recurs. We devised a method of colonoscopy-assisted percutaneous sigmoidopexy as an alternative method to prevent recurrence of sigmoid volvulus. This study aimed to assess its safety and effectiveness.

METHODS:

Patients with sigmoid volvulus American Society of Anesthesiologists physical status classification ≥3 or Barthel index <30 were included. We excluded patients with intestinal necrosis and those who were unable to be repositioned but who could undergo intestinal resection. Colonoscopy-assisted sigmoidopexy was performed under radiographic observation. First, a colonoscope was inserted to the fixation site. A site for percutaneous puncture of the colon was identified by transmitted illumination and finger pressure. An exploratory puncture through the abdominal wall was made with a 23-gauge cattelan needle with the patient under local anesthesia, followed by a skin incision. Sigmoid fixation was then performed using a 2-shot anchor device that allows the sigmoid colon to be sutured to the abdominal wall. Fixation was repeated at 5 to 10 sites (average 8.8). The primary outcome measurement was sigmoid volvulus recurrence within 12 months. The secondary outcome measurement was adverse events.

RESULTS:

Eight patients received colonoscopy-assisted sigmoidopexy, and no sigmoid volvulus recurred during the 12-month follow-up period. One case of postoperative subcutaneous emphysema was successfully managed with conservative therapy.

CONCLUSION:

Colonoscopy-assisted sigmoidopexy was an effective, safe alternative method to prevent the recurrence of sigmoid volvulus.

• Authors: Tomonori Imakita, Yutaka Suzuki, Hironori Ohdaira, Mitsuyoshi Urashima
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 90 Issue 3 Pg. 514-520 (09 2019) ISSN: 1097-6779 [Electronic] United States
• PMID: 31077700 (Publication Type: Journal Article, Video-Audio Media)
• Copyright: Copyright © 2019 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Topics

• Abdominal Wall (surgery)
• Adult
• Aged
• Aged, 80 and over
• Colon, Sigmoid (surgery)
• Colonography, Computed Tomographic
• Colonoscopy (methods)
• Female
• Humans
• Intestinal Volvulus (surgery)
• Male
• Middle Aged
• Postoperative Complications (therapy)
• Punctures (methods)
• Plastic Surgery Procedures (methods)
• Recurrence
• Sigmoid Diseases (surgery)
• Subcutaneous Emphysema (therapy)
• Suture Techniques
• Treatment Outcome