TP9.2.30Sigmoid Volvulus: Is a More Aggressive Approach Justified? Results of a Retrospective Cohort Study

Abstract Aims Sigmoid volvulus is a common cause of emergency surgical admission. It often affects older males who are institutionalised and are less suitable surgical candidates. Definitive treatment is surgical but first line treatment is via endoscopic devolution with or without placement of a rectal tube. After non-operative management recurrence is likely and carries a high mortality, therefore an early surgical approach may be considered in patients who are fit for surgery. We have retrospectively analysed a cohort of patients with sigmoid volvulus in order to clarify if and when a more aggressive management is indicated. Methods We have reviewed data on admitted patients diagnosed with sigmoid volvulus over a 2-year period. Demographic, clinical data, morbidity and mortality were recorded in a database. Analysis was carried out with statistical programs. The primary endpoint was patient survival. Secondary endpoint was the estimation of the factors that condition surgical choice. Results We analysed 78 cases. 74.4% had multiple admissions and recurrences. 39.7% of patients underwent surgical resection. The average survival was 54.9±8.8 months from the first hospitalisation, irrespective of the treatment. Long-term survival was positively influenced by being female, having a low “social score”, a younger age and surgery. Multivariate analysis showed that only being female and surgery were independently associated with better survival. Conclusions In conclusion, we believe that early surgery may be the best approach in patients with recurrent sigmoid volvulus, as it ensures longer survival with a better quality of life, regardless of the patient's social and functional condition.

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Prognostic Factors in the Decision-Making Process for Sigmoid Volvulus. Results of a Single-Centre Retrospective Cohort Study.

10.21203/rs.3.rs-302366/v1 ◽

2021 ◽

Author(s):

Zoe Slack ◽

Mohamed Shams ◽

Raheel Ahmad ◽

Roshneen Ali ◽

Diandra Antunes ◽

...

Keyword(s):

Operative Management ◽

Functional Condition ◽

Sigmoid Volvulus ◽

Definitive Treatment ◽

Rectal Tube ◽

Term Survival ◽

Average Survival ◽

Younger Age ◽

Non Operative Management

Abstract BACKGROUND: Sigmoid volvulus is a common cause of emergency surgical admission. It often affects older males who are institutionalized and are less suitable surgical candidates. Definitive treatment is surgical, but first line treatment is via endoscopic devolution with or without placement of a rectal tube. After non-operative management recurrence is likely and carries a high mortality, therefore an early surgical approach may be considered in patients who are fit for surgery. We have retrospectively analyzed a cohort of patients with sigmoid volvulus in order to clarify if and when a more aggressive management is indicated.METHODS: We have reviewed data on admitted patients diagnosed with sigmoid volvulus over a 2-year period. Demographic, clinical data, morbidity and mortality were recorded in a database. The primary endpoint was patient survival. Secondary endpoint was the estimation of the factors that condition surgical choice.RESULTS: We analysed 332 admission of 78 patients. 39.7% of patients underwent surgical resection. The average survival was 54.9±8.8 months from the first hospitalization, irrespective of the treatment. Long-term survival was positively influenced by being female, having a low "social score", a younger age and surgery. Multivariate analysis showed that only being female and surgery were independently associated with better survival.CONCLUSION: Early surgery may be the best approach in patients with recurrent sigmoid volvulus, as it ensures longer survival with a better quality of life, regardless of the patient's social and functional condition.

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Interventional radiology versus operative management for splenic injuries: a study protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-028172 ◽

2019 ◽

Vol 9 (8) ◽

pp. e028172

Author(s):

Masahiro Kashiura ◽

Noritaka Yada ◽

Kazuma Yamakawa

Keyword(s):

Systematic Review ◽

Interventional Radiology ◽

Meta Analysis ◽

Operative Management ◽

Sensitivity Analyses ◽

Definitive Treatment ◽

Controlled Trials ◽

Cochrane Central Register ◽

Statistical Heterogeneity ◽

Non Operative Management

IntroductionOver the past decades, the treatment for blunt splenic injuries has shifted from operative to non-operative management. Interventional radiology such as splenic arterial embolisation generally increases the success rate of non-operative management. However, the type of intervention, such as the first definitive treatment for haemostasis (interventional radiology or surgery) in blunt splenic injuries is unclear. Therefore, we aim to clarify whether interventional radiology improves mortality in patients with blunt splenic trauma compared with operative management by conducting a systematic review and meta-analysis.Methods and analysisWe will search the following electronic bibliographic databases to retrieve relevant articles for the literature review: Medline, Embase and the Cochrane Central Register of Controlled Trials. We will include controlled trials and observational studies published until September 2018. We will screen search results, assess the study population, extract data and assess the risk of bias. Two review authors will extract data independently, and discrepancies will be identified and resolved through a discussion with a third author where necessary. Data from eligible studies will be pooled using a random-effects meta-analysis. Statistical heterogeneity will be assessed by using the Mantel-Haenszel χ² test and the I² statistic, and any observed heterogeneity will be quantified using the I² statistic. We will conduct sensitivity analyses according to several factors relevant for the heterogeneity.Ethics and disseminationOur study does not require ethical approval as it is based on the findings of previously published articles. This systematic review will provide guidance on selecting a method for haemostasis of splenic injuries and may also identify knowledge gaps that could direct further research in the field. Results will be disseminated through publication in a peer-reviewed journal and presentations at relevant conferences.PROSPERO registration numberCRD42018108304.

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Recurrent Sigmoid Volvulus – Early Resection may Obviate Later Emergency Surgery and Reduce Morbidity and Mortality

Annals of The Royal College of Surgeons of England ◽

10.1308/003588409x391776 ◽

2009 ◽

Vol 91 (3) ◽

pp. 205-209 ◽

Cited By ~ 30

Author(s):

JO Larkin ◽

TB Thekiso ◽

R Waldron ◽

K Barry ◽

PW Eustace

Keyword(s):

Emergency Surgery ◽

Hospital Admissions ◽

Elective Surgery ◽

Postoperative Mortality ◽

Operative Management ◽

Sigmoid Volvulus ◽

High Rate ◽

Colonoscopic Decompression ◽

Non Operative Management ◽

Overall Mortality

INTRODUCTION Acute sigmoid volvulus is a well recognised cause of acute large bowel obstruction. PATIENTS AND METHODS We reviewed our unit's experience with non-operative and operative management of this condition. A total of 27 patients were treated for acute sigmoid volvulus between 1996 and 2006. In total, there were 62 separate hospital admissions. RESULTS Eleven patients were managed with colonoscopic decompression alone. The overall mortality rate for non-operative management was 36.4% (4 of 11 patients). Fifteen patients had operative management (five semi-elective following decompression, 10 emergency). There was no mortality in the semi-elective cohort and one in the emergency surgery group. The overall mortality for surgery was 6% (1 of 15). Five of the seven patients managed with colonoscopic decompression alone who survived were subsequently re-admitted with sigmoid volvulus (a 71.4% recurrence rate). The six deaths in our overall series each occurred in patients with established gangrene of the bowel. With early surgical intervention before the onset of gangrene, however, good outcomes may be achieved, even in patients apparently unsuitable for elective surgery. Eight of the 15 operatively managed patients were considered to be ASA (American Society of Anesthesiologists) grade 4. There was no postoperative mortality in this group. CONCLUSIONS Given the high rate of recurrence of sigmoid volvulus after initial successful non-operative management and the attendant risks of mortality from gangrenous bowel developing with a subsequent volvulus, it is our contention that all patients should be considered for definitive surgery after initial colonoscopic decompression, irrespective of the ASA score.

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Long-Term Survival in Cerebral Glioblastoma. Case Report and Critical Review of the Literature

Tumori Journal ◽

10.1177/030089169808400115 ◽

1998 ◽

Vol 84 (1) ◽

pp. 69-74 ◽

Cited By ~ 14

Author(s):

Fabrizio Puzzilli ◽

Andrea Ruggeri ◽

Luciano Mastronardi ◽

Domenica Di Stefano ◽

Pierpaolo Lunardi

Keyword(s):

Glioblastoma Multiforme ◽

Multimodal Therapy ◽

Term Survival ◽

Disease Free Interval ◽

Average Survival ◽

Younger Age ◽

Aggressive Tumor ◽

Long Term Survivors ◽

Disease Free

Glioblastoma multiforme is the most malignant tumor of the glial series. The average survival of patients with this tumor ranges from 6 to 12 months. The case of a patient who survived for more than 11 years after diagnosis of a temporal-occipital glioblastoma which was treated with surgery, radiotherapy and chemotherapy is described. The authors deduce that among patients with glioblastoma multiforme (GM), those with a long disease-free interval after initial diagnosis who undergo multimodal therapy, including aggressive tumor removal, are the most likely long-term survivors (LS). Other factors which appeared to be related to longer survival were younger age and high Karnofsky scores.

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Sarcopenia Predicts Long Term Survival in Patients with Thoracoabdominal Aortic Aneurysms Undergoing Operative and Non-Operative Management

Journal of Vascular Surgery ◽

10.1016/j.jvs.2021.08.065 ◽

2021 ◽

Author(s):

Amir A. Ghaffarian ◽

Jaryd Unangst ◽

Matthew A. Bartek ◽

Karina Newhall ◽

P. Chuhli Kang ◽

...

Keyword(s):

Operative Management ◽

Aortic Aneurysms ◽

Term Survival ◽

Long Term Survival ◽

Non Operative Management

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Sigmoid volvulus: definitive surgery is safe and should be considered in all instances

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02713-0 ◽

2021 ◽

Author(s):

Niall P. Hardy ◽

Philip D. McEntee ◽

Paul H. McCormick ◽

Brian J. Mehigan ◽

John O. Larkin

Keyword(s):

Elective Surgery ◽

The Elderly ◽

Operative Management ◽

Large Bowel Obstruction ◽

Sigmoid Volvulus ◽

High Rate ◽

High Recurrence Rate ◽

Patient Demographics ◽

Definitive Surgery ◽

Non Operative Management

Abstract Background Acute sigmoid volvulus (ASV) represents a small but significant portion of cases of large bowel obstruction, especially in the elderly and co-morbid. Given the characteristics of the patient cohort most commonly affected, a non-operative/conservative approach is often undertaken but is associated with a high rate of recurrence. Objective We sought to evaluate outcomes for those patients who underwent non-operative management, emergency surgery or staged, semi-elective surgery following decompression for ASV at our institution. Methods Hospital in-patient enquiry (HIPE) data were used to identify all patients who presented with sigmoid volvulus between January 2005 and June 2020 inclusive. Patient notes were interrogated, including surgical and endoscopic procedures performed. Patient demographics and co-morbidities were recorded. Results Thirty-nine patients were treated over a 15-year period with a mean age of 73 years at first presentation (range 36–93). Twenty-two patients (56%) had just a single admission for ASV with three deaths in this group. Seventeen patients (44%) had more than one admission with volvulus due to recurrence after a decompression-only strategy on the index admission. Of these, three succumbed to complications of their subsequent episodes of volvulus. Twenty-five patients underwent surgical intervention (fifteen on, or shortly following, their first admission and ten following at least two admissions for ASV). The overall mortality in the operative group was 2/25 (8%) with both deaths in those undergoing emergency surgeries. Five patients were treated successfully with endoscopic measures alone and had required no further interventions at the time of compiling data. Conclusion There is a high recurrence rate following non-operative management of acute sigmoid volvulus and consequently, a cumulative increase in the attendant significant morbidity and mortality with subsequent episodes. Given the relatively low complication rate of definitive surgery, even in those patients perceived to be high risk, we contend that all patients should be considered for early surgery to prevent the likely recurrence of sigmoid volvulus.

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594 Optimising Hand Trauma Care at a Major Trauma Centre (MTC) During the COVID-19 Pandemic

British Journal of Surgery ◽

10.1093/bjs/znab134.070 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A Khajuria

Keyword(s):

Operative Management ◽

Trauma Centre ◽

Definitive Treatment ◽

Face To Face ◽

Major Trauma Centre ◽

Treatment Centre ◽

One Stop ◽

The One ◽

Non Operative Management

Abstract Introduction This study evaluates the management of hand injuries during COVID-19 following the prompt implementation of the BOA guidelines; reconfiguration of hand services and implementation of the ‘one-stop’ model. Method 285 cases OVER A 1-MONTH PERIOD were RETROSPECTIVELY reviewed to evaluate the effectiveness of managing patients using the ‘one-stop’ model and the new Urgent Treatment Centre (UTC). Results 277 patients were included in the study. During Covid-19, operative cases fell by 62%. 86.3% (239/277) of cases were managed in the UTC; 54.4% (130/239) required conservative management and 45.6% (109/239) required minor procedures (in UTC). REMOVABLE SPLINT USE was optimized through design of ‘softcasts’ for non-operative management of distal radius fractures. A patient education video: ‘softcast removal at home’ was created and in cases requiring sutures, 95.1% (39/41) were absorbable, thereby avoiding COVID-19 exposure for follow-up. Only 50.5% (140/277) of patients had formal follow-up arranged and patient information follow-up cards were developed. Conclusions The one-stop model prevents delay in definitive treatment, allows effective initial treatment, and minimizes the need for face-to-face follow up. In light of a possible second wave of COVID-19 cases, this new model should be considered for implementation by all hand’s units for the foreseeable future.

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P50. Comparison of long-term survival outcomes of operative versus non-operative management of recurrent rectal cancer

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2012.07.171 ◽

2012 ◽

Vol 38 (11) ◽

pp. 1119-1120

Author(s):

Aneel Bhangu ◽

Mohammed Ali ◽

Gina Brown ◽

Paris Tekkis

Keyword(s):

Rectal Cancer ◽

Operative Management ◽

Recurrent Rectal Cancer ◽

Survival Outcomes ◽

Term Survival ◽

Long Term Survival ◽

Non Operative Management

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A rare presentation of aorto-bronchial fistula and the relevance of open repair in endovascular era

International Surgery Journal ◽

10.18203/2349-2902.isj20202855 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2393

Author(s):

M. Faizal Effendi Zulkifli ◽

M. Azri Marican ◽

Abdul Rashid M. Radzif ◽

Muhammad Ibrahim Azmi ◽

Mohamad Arif Muhammad ◽

...

Keyword(s):

Lower Lobe ◽

Lung Parenchyma ◽

Operative Management ◽

Massive Bleeding ◽

Definitive Treatment ◽

Rare Presentation ◽

Bronchial Fistula ◽

Aorta Aneurysm ◽

Non Operative Management ◽

Thoracic Aorta Aneurysm

Aorto-bronchial fistula is a rare but potentially fatal condition due to torrential bleeding from erosion of aneurysmal wall into bronchial wall or lung parenchyma. It is usually associated with infection, lung transplantation, pulmonary malignancies, atherosclerotic and mycotic aneurysms, and anastomotic pseudoaneurysms after open or endovascular surgery. The typical presentation usually manifested by haemoptysis, but rarely the patient also can be presented with hematemesis and this will delay the definitive treatment. Surgical or endovascular repair is mandatory because non-operative management will lead to a poor prognosis due to massive bleeding from the fistula. We would like to present a unique case of an elderly man presented with intermittent haematemesis, in which he later developed profound haemoptysis and diagnosed with ABF. Although in the era of endovascular, the ABF was successfully treated via open thoracotomy, resection of thoracic aorta aneurysm, left lower lobe lobectomy, and completed with aortic repair using Gelweave aortic graft.

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