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.

journal_name

Gastrointest Endosc

authors

Imakita T,Suzuki Y,Ohdaira H,Urashima M

doi

10.1016/j.gie.2019.04.246

subject

Has Abstract

pub_date

2019-09-01 00:00:00

pages

514-520

issue

3

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(19)31676-1

journal_volume

90

pub_type

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