Comparison of primary resection and anastomosis with Hartmann’s procedure in management of acute sigmoid volvulus

Abstract

Background

Sigmoid volvulus is a common surgical emergency in many regions of the world that carries significant morbidity and mortality. Volvulus occurs when an air-filled segment of the colon twists about its mesentery. In developing countries, it is a major cause of colonic obstruction. The sigmoid colon is involved in up to 90% of cases. It can be present as acute, sub-acute or chronic. Acute sigmoid volvulus requires emergency surgery. Various methods are used in its management.

Aim

The purpose of our study was to evaluate the comparative study of single-stage resection and anastomosis with Hartmann's procedure for management of acute left-sided colonic obstruction due to acute sigmoid volvulus.

Methods

This prospective study was conducted in a consecutive series of 122 patients with acute sigmoid volvulus, admitted to the department of general surgery at M.K.C.G Medical College. All 122 patients were submitted to laparotomy. In different groups, 87 patients underwent primary resection of the affected sigmoid colon with anastomosis while 35 patients underwent surgical resection of the rectosigmoid colon with closure of the rectal stump and formation of an end colostomy (Hartmann's procedure). The outcome of the two procedures was analysed in terms of mortality, postoperative complications and hospital stay.

Results

This study clearly shows that there is no statistically significant result between the two procedures, other than a slightly longer hospital stay recorded for the resection and anastomosis group than that of the Hartmann's group.

Conclusion

This study demonstrated that the outcome of two procedures are the same. Resection and anastomosis should be performed safely in uncomplicated acute sigmoid; in complicated cases, Hartmann's procedure is the surgery of choice.

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