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

2009 ◽  
Vol 91 (3) ◽  
pp. 205-209 ◽  
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.

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

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.

Chemotherapy first, followed by chemoradiation (CRT) and then surgery, in the management of locally advanced rectal cancer (LARC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3605-3605
Author(s):  
Andrea Cercek ◽  
Karyn A. Goodman ◽  
Carla Hajj ◽  
Emily Weisberger ◽  
Neil Howard Segal ◽  
...  
Keyword(s):  
Clinical Response ◽  
Tumor Response ◽  
Tumor Regression ◽  
Clinical Stage ◽  
Locally Advanced ◽  
Operative Management ◽  
High Rate ◽  
Complete Clinical Response ◽  
Response To Chemotherapy ◽  
Non Operative Management

3605 Background: Standard pre-op CRT and post-op chemo for LARC delays the start of optimal systemic therapy by 18-22 weeks. To more promptly address micrometastases that could lead to distant failure, and supported by evidence of excellent primary tumor response to FOLFOX, we began offering FOLFOX as initial treatment for patients (pts) with high-risk LARC. More recently, we have begun offering all planned FOLFOX prior to CRT and surgery. Methods: We obtained an IRB waiver to review records of all clinical stage II/III RC pts treated with initial FOLFOX followed by CRT and total mesorectal excision (TME) at our institution between 2007 and 2012. Of approximately 300 rectal pts treated with CMT, 61 received some or all of their planned FOLFOX as initial therapy. Results: The median age of these 61 pts was 52 years, 54% male. At diagnosis, 84% had T3N1-2 or T4N0-1 tumors and 16% had T3N0 tumors. Of these, 57 received induction FOLFOX (median 7 cycles) then received pre-op CRT, while 4 pts achieved an excellent response to chemotherapy alone, declined CRT, and went directly to TME. Twelve pts did not undergo surgery; 9 had a complete clinical response and elected to be managed non-operatively; 1 refused recommended surgery despite incomplete tumor regression, 1 had surgery deferred due to comorbidities, and 1 developed distant metastatic disease prior to planned surgery. Of the 61 patients, 19 (31%) had either a pathCR (14) or a complete clinical response (5) leading to non-operative management. Of the 49 pts who underwent TME, all had R0 resections and 23 (47%) had tumor response >90%, including 13 (27%) with pathCR. Of the 28 patients who received all 8 cycles of initial FOLFOX, 8 achieved a pathCR (29%) and 3 achieved a complete clinical responses (11%), managed non-operatively. All patients completed therapy as planned. There were no SAEs requiring delay in treatment during either FOLFOX or CMT. Conclusions: FOLFOX before CRT results in substantial tumor regression, a high rate of delivery of all planned therapy, and a substantial rate of pathCRs. Chemo and CMT before planned TME provides a favorable opportunity for consideration of non-operative management.

scholarly journals Surgical Management of Sigmoid Volvulus: A Multicenter Observational Study

2020 ◽  
Vol 36 (6) ◽  
pp. 403-408
Author(s):  
Keunchul Lee ◽  
Heung-Kwon Oh ◽  
Jung Rae Cho ◽  
Minhyun Kim ◽  
Duck-Woo Kim ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Emergency Surgery ◽  
Open Surgery ◽  
Elective Surgery ◽  
Operation Time ◽  
Sigmoid Volvulus ◽  
Common Procedure ◽  
Multicenter Observational Study ◽  
Emergency Procedures ◽  
Stoma Formation

Purpose: This study aimed to evaluate real-world clinical outcomes from surgically treated patients for sigmoid volvulus.Methods: Five tertiary centers participated in this retrospective study with data collected from October 2003 through September 2018, including demographic information, preoperative clinical data, and information on laparoscopic/open and elective/emergency procedures. Outcome measurements included operation time, postoperative hospitalization, and postoperative morbidity.Results: Among 74 patients, sigmoidectomy was the most common procedure (n = 46), followed by Hartmann’s procedure (n = 23), and subtotal colectomy (n = 5). Emergency surgery was performed in 35 cases (47.3%). Of the 35 emergency patients, 34 cases (97.1%) underwent open surgery, and a stoma was established for 26 patients (74.3%). Elective surgery was performed in 39 cases (52.7%), including 21 open procedures (53.8%), and 18 laparoscopic surgeries (46.2%). Median laparoscopic operation time was 180 minutes, while median open surgery time was 130 minutes (P < 0.001). Median postoperative hospitalization was 11 days for laparoscopy and 12 days for open surgery. There were 20 postoperative complications (27.0%), and all were resolved with conservative management. Emergency surgery cases had a higher complication rate than elective surgery cases (40.0% vs. 15.4%, P = 0.034).Conclusion: Relative to elective surgery, emergency surgery had a higher rate of postoperative complications, open surgery, and stoma formation. As such, elective laparoscopic surgery after successful sigmoidoscopic decompression may be the optimal clinical option.

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

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.

EP.FRI.8 Hajibandeh index predicts nature of peritoneal contamination and risk of postoperative mortality in patients with acute abdominal pathology: A multicentre cohort study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahab Hajibandeh ◽  
Shahin Hajibandeh ◽  
Jigar Shah ◽  
Moustafa Mansour
Keyword(s):  
Cohort Study ◽  
Validation Cohort ◽  
Postoperative Mortality ◽  
Operative Management ◽  
Emergency Laparotomy ◽  
Roc Curve Analysis ◽  
Peritoneal Contamination ◽  
Multicentre Cohort Study ◽  
Non Operative Management ◽  
Multicentre Cohort

Abstract Aims To develop and validate intraperitoneal contamination index, Hajibandeh Index (HI), derived from combined levels of CRP, lactate, neutrophils, lymphocytes and albumin in predicting the nature of peritoneal contamination and risk of postoperative mortality in patients with acute abdominal pathology. Methods A multicentre cohort study was conducted to develop and validate an index to predict presence of purulent and feculent contamination and risk of postoperative mortality in patients with acute abdominal pathology. All adult patients with acute abdominal pathology requiring emergency laparotomy between 2014 and 2020 were included. The index was developed in a primary cohort and was validated in retrospective and prospective validation cohorts. ROC curve analysis was performed to determine discrimination of the index and cut-off values of HI that could predict nature of peritoneal contamination and postoperative mortality. Results 737 patients were included (234 in primary cohort, 234 in retrospective validation cohort, and 269 in prospective validation cohort). The analyses identified HI of 24.76 as cut-off value for purulent contamination (AUC:0.78,P&lt;0.0001;sensitivity:82.4%,specificity:60.9%); HI of 33.84 as cut-off value for feculent contamination (AUC:0.78, P&lt;0.0001;sensitivity:82%,specificity:67.8%), and HI of 33.47 as cut-off value for postoperative mortality (AUC:0.70,P&lt;0.0001;sensitivity:72.7%, specificity:58.47%). The results of the primary cohort and validation cohorts were comparable. Conclusions HI predicts presence of purulent and feculent contamination in patients with acute abdominal pathology and risk of postoperative mortality in patients undergoing emergency laparotomy. Future studies should investigate the effect of HI on accuracy of preoperative prognostic scoring tools and on patient selection for operative or non-operative management of underlying abdominal pathology.

A Reappraisal of Outcome of Elective Surgery After Successful Non-Operative Management of an Intra-Abdominal Abscess Complicating Ileocolonic Crohn’s Disease: A Subgroup Analysis of a Nationwide Prospective Cohort

2020 ◽  
Author(s):  
M K Collard ◽  
S Benoist ◽  
L Maggiori ◽  
P Zerbib ◽  
J H Lefevre ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Propensity Score ◽  
Prospective Cohort ◽  
Elective Surgery ◽  
Fluid Collection ◽  
Operative Management ◽  
Abdominal Abscess ◽  
Long Term Outcomes ◽  
Non Operative Management

Abstract Background and Aims Few prospective data exist on outcomes of surgery in Crohn’s disease [CD] complicated by an intra-abdominal abscess after resolution of this abscess by antibiotics optionally combined with drainage. Methods From 2013 to 2015, all patients undergoing elective surgery for CD after successful non-operative management of an intra-abdominal abscess [Abscess-CD group] were selected from a nationwide multicentre prospective cohort. Resolution of the abscess had to be computed tomography/magnetic resonance-proven prior to surgery. Abscess-CD group patients were 1:1 matched to uncomplicated CD [Non-Penetrating-CD group] using a propensity score. Postoperative results and long-term outcomes were compared between the two groups. Results Among 592 patients included in the registry, 63 [11%] fulfilled the inclusion criteria. The abscess measured 37 ± 20 mm and was primarily managed with antibiotics combined with drainage in 14 patients and nutritional support in 45 patients. At surgery, a residual fluid collection was found in 16 patients [25%]. Systemic steroids within 3 months before surgery [p = 0.013] and the absence of preoperative enteral support [p = 0.001] were identified as the two significant risk factors for the persistence of a fluid collection. After propensity score matching, there was no significant difference between the Abscess-CD and Non-Penetrating-CD groups in the rates of primary anastomosis [84% vs 90% respectively, p = 0.283], overall [28% vs 15% respectively, p = 0.077] and severe postoperative morbidity [7% vs 7% respectively, p = 1.000]. One-year recurrence rates for endoscopic recurrence were 41% in the Abscess-CD and 51% in the Non-Penetrating-CD group [p = 0.159]. Conclusions Surgery after successful non-operative management of intra-abdominal abscess complicating CD provides good early and long-term outcomes.

scholarly journals Renal trauma: a 5-year retrospective review in single institution

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Syarif ◽  
Achmad M. Palinrungi ◽  
Khoirul Kholis ◽  
Muhammad Asykar Palinrungi ◽  
Syakri Syahrir ◽  
...  
Keyword(s):  
Operative Management ◽  
Organ Injury ◽  
Renal Trauma ◽  
Solid Organ ◽  
Mechanism Of Injury ◽  
Current Management ◽  
Injury Management ◽  
Icd 10 ◽  
Non Operative Management ◽  
Overall Mortality

Abstract Background Renal trauma occurs in up to 5% of all trauma cases and accounts for 24% of abdominal solid organ injuries. Renal trauma management has evolved over the past decades, and current management is transitioning toward more conservative approaches for the majority of hemodynamically stable patients. The objective of this study was to analyze the mechanism of injury, management, and outcome in renal trauma. Methods Patients diagnosed with renal trauma in Makassar, Indonesia, from January 2014 to December 2018 were identified retrospectively by the ICD-10 code. Data were collected from medical records. Imaging was classified by radiologists. Variables analyzed included age, sex, mechanism of injury, degree of renal trauma, related organ injury, management, and outcome. Results Out of the 68 patients identified, the average age was 23.9 ± 0.6 years, and most were male (83.8%). Blunt trauma accounted for 89.7% of all cases. The most common renal injuries were grade IV (42.6%), and 14% of the cases had no hematuria. Most patients were treated with non-operative management (NOM). Nephrectomy was performed in 16.2% of cases, and 5.9% of cases underwent renorrhaphy. It was found that 58.8% of cases had isolated renal trauma, and the overall mortality rate (2.9%) was due to related injuries. Conclusions The majority of blunt and penetrating renal trauma cases that are hemodynamically stable have a good outcome when treated with NOM. The presence of injury in other important organs both intra- and extra-abdominally aggravates the patient’s condition and affects the prognosis.

scholarly journals Diagnosis and Treatment of Obturator Hernia: Retrospective Analysis of 86 Clinical Cases at a Single Institution.

2020 ◽  
Author(s):  
ZHENGZHENG LI ◽  
Chaoyang Gu ◽  
Mingtian Wei ◽  
Xing Yuan ◽  
Ziqiang Wang
Keyword(s):  
Postoperative Complications ◽  
Emergency Surgery ◽  
Bowel Resection ◽  
Elective Surgery ◽  
Gastrointestinal Surgery ◽  
Intestinal Resection ◽  
Postoperative Mortality ◽  
Obturator Hernia ◽  
Diagnosis And Treatment ◽  
Surgery Group

Abstract Background: To explore the clinical characteristics, diagnosis and treatment of obturator hernia.Methods: Eighty-six patients who were diagnosed as obturator hernia by abdominal CT in the Department of Gastrointestinal Surgery of our hospital between 2009 and 2019 were enrolled in this study. Patient characteristics, surgical method, postoperative complications and mortalities were retrospectively reviewed, and the patients were followed by telephone or clinic visit to check for the recurrence.Results: 30 days mortality rate of 5.5% and 46.1% were observed in surgery group and non-surgery group, respectively. Surgery was performed as an emergency procedure in 59 cases and elective procedure in 14 cases depending on different hernia contents, intestinal necrosis and signs of peritonitis. In the emergency surgery group, segmental intestinal resection with anastomosis was performed in 24 patients(24/59, 40.7%). There were 4 deaths(4/59, 6.8%) in this group ,all of which occurred in patients undergoing SI resections. In contrast, no bowel resection, postoperative complications, or death occurred in the elective surgery group. 3 -year recurrence rates of 5.1% (3/59)and 7.1%(1/14) were observed in the emergency surgery and the elective surgery group, respectively. Conclusions: CT examination plays an important role in improving the diagnostic rate of obturator hernia. In elderly people with comorbidities, timely surgical treatment is the key to improve the efficacy of obturator hernia and prevent the deterioration of the condition. In addition, postoperative mortality is significantly associated with bowel resection and postoperative complications.

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

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Zoe Slack ◽  
Mohamed Shams ◽  
Mahmoud Sallam ◽  
Giles Bond-Smith ◽  
Giovanni Tebala
Keyword(s):  
Operative Management ◽  
Functional Condition ◽  
Sigmoid Volvulus ◽  
Definitive Treatment ◽  
Rectal Tube ◽  
Term Survival ◽  
Aggressive Approach ◽  
Average Survival ◽  
Younger Age ◽  
Non Operative Management

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.

scholarly journals Impact of COVID-19 on orthopaedic care: a call for nonoperative management

2020 ◽  
Vol 12 ◽  
pp. 1759720X2093427 ◽  
Author(s):  
Mark R. Phillips ◽  
Yaping Chang ◽  
Robert D. Zura ◽  
Samir Mehta ◽  
Peter V. Giannoudis ◽  
...  
Keyword(s):  
Surgical Management ◽  
Operative Treatment ◽  
Surgical Procedures ◽  
Elective Surgery ◽  
Treatment Options ◽  
Operative Management ◽  
Management Options ◽  
Orthopaedic Care ◽  
Elective Surgical Procedures ◽  
Non Operative Management

Background: Surgical specialties face unique challenges caused by SARS-COV-2 (COVID-19). These disruptions will call on clinicians to have greater consideration for non-operative treatment options to help manage patient symptoms and provide therapeutic care in lieu of the traditional surgical management course of action. This study aimed to summarize the current guidance on elective surgery during the COVID-19 pandemic, assess how this guidance may impact orthopaedic care, and review any recommendations for non-operative management in light of elective surgery disruptions. Methods: A systematic search was conducted, and included guidance were categorized as either “Selective Postponement” or “Complete Postponement” of elective surgery. Selective postponement was considered as guidance that suggested elective cases should be evaluated on a case-by-case basis, whereas complete postponement suggested that all elective procedures be postponed until after the pandemic, with no case-by-case consideration. In addition, any statements regarding conservative/non-operative management were summarized when provided by included reports. Results: A total of 11 reports from nine different health organizations were included in this review. There were seven (63.6%) guidance reports that suggested a complete postponement of non-elective surgical procedures, whereas four (36.4%) reports suggested the use of selective postponement of these procedures. The guidance trends shifted from selective to complete elective surgery postponement occurred throughout the month of March. The general guidance provided by these reports was to have an increased consideration for non-operative treatment options whenever possible and safe. As elective surgery begins to re-open, non-operative management will play a key role in managing the surgical backlog caused by the elective surgery shutdown. Conclusion: Global guidance from major medical associations are in agreement that elective surgical procedures require postponement in order to minimize the risk of COVID-19 spread, as well as increase available hospital resources for managing the influx of COVID-19 patients. It is imperative that clinicians and patients consider non-operative, conservative treatment options in order to manage conditions and symptoms until surgical management options become available again, and to manage the increased surgical waitlists caused by the elective surgery shutdowns.

Sign in / Sign up

Export Citation Format

Share Document