Comparison of primary resection and anastomosis with hartmanns procedure in management of acute sigmoid volvulus

Abstract

Background: Sigmoid volvulus is a common surgical emergency in many regions of the world, with 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. Emergency operation is needed in acute sigmoid volvulus. Various methods are used in the management. 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 retrospective study was conducted in a consecutive series of 122 patients, admitted to M. K. C. G. Medical College in the department of general surgery, with acute sigmoid volvulus. Then laparotomy were carried out in all 122 patients, primary resection of the affected sigmoid colon with anastomosis were done in 87 patients and the surgical resection of the recto-sigmoid colon with closure of the rectal stump and formation of an end colostomy (Hartmann's procedure) in 35 patients were done in different groups. Outcome of the two procedures analyzed in terms of mortality, post-operative complications, and hospital stay. Results: This study clearly showed that there is no such statistically significant result compared to both groups. Except little bit longer hospital stay in resection and anastomosis group than Hartmann’s group. Conclusions: This study demonstrated that outcome of two procedures are same. Resection and anastomosis should be done in uncomplicated acute sigmoid volvulus safely, but in case of complicated patients Hartmann’s procedure is the choice of operation.