Minilaparotomy without general anesthesia for the treatment of sigmoid volvulus in high-risk patients: A case series of 4 patients.

BACKGROUND: Sigmoid volvulus (SV) is a common cause of large bowel obstruction worldwide. Presenting symptoms can be nonspecific and varied amongst the elderly population, making medical and surgical management challenging. This population is at markedly increase risk of complications and mortality with surgery under general anesthesia. In this case series, we describe 4 cases of sigmoid volvulus in octogenarians.

GOALS: To demonstrate that sigmoid colectomy under local anesthesia, with or without intravenous conscious sedation, is feasible and can be done safely and with a low rate of converting to a general anesthetic.

RESULTS: Four patients, mean age 90 years, were admitted a total of 4 times for acute sigmoid volvulus. All patients had serious comorbidities and were classified as ASA III. There was no relevant past surgical history. All patients were severely physically deconditioned but alert and able to interact meaningfully with their families and caregivers. Three patients suffered recurrent volvulus following endoscopic decompression and one patient underwent immediate surgery due to abdominal tenderness.

CONCLUSION: Our experience demonstrates that minilaparotomy for sigmoid volvulus is effective and safe. The techniques and can extend the applicability of definitive surgical intervention to this high-risk population of patients. In our series postoperative outcomes were excellent, however, additional studies are needed to determine if this technique results in improved 30-day and long-term mortality and morbidity in high-risk patients and to determine the utility of extending the technique to all patients with sigmoid volvulus.