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.
journal_name
Gastrointest Endoscjournal_title
Gastrointestinal endoscopyauthors
Imakita T,Suzuki Y,Ohdaira H,Urashima Mdoi
10.1016/j.gie.2019.04.246subject
Has Abstractpub_date
2019-09-01 00:00:00pages
514-520issue
3eissn
0016-5107issn
1097-6779pii
S0016-5107(19)31676-1journal_volume
90pub_type
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