Risk of recurrence of sigmoid volvulus: a single-centre cohort study.
AIM
Sigmoid volvulus is a condition with a tendency to recur if treated conservatively. Little is known about the best type of treatment or when to perform definitive surgery. The aim of this study was to review treatment, and assess the outcome, of sigmoid volvulus in adult patients treated at a Swedish university hospital.


METHOD
The medical records of patients treated for sigmoid volvulus at Sahlgrenska University Hospital, Sweden from January 2000 to September 2016 were reviewed retrospectively. Median follow-up time was 8.3 years.


RESULTS
One hundred and sixty-eight patients were included with a total of 453 admissions for sigmoid volvulus. Nonoperative decompression was attempted as the initial treatment in 438/453 (97%), with a success rate of 92% (403/438), which was not influenced by whether it was the first episode or a recurrence. Without planned surgery, recurrence occurred after 84% of successful nonoperative decompressions with a median of two recurrences (1-16). Recurrence was less common after the first episode compared with subsequent episodes. Median time until recurrence was 58 days. Mortality after planned surgery following successful decompression was 3.3% (2/61) compared with 13% (6/46) following emergency surgery.


CONCLUSION
In our cohort, the recurrence rate of sigmoid volvulus following successful nonoperative decompression was high. Still, more than 20% of patients did not experience a recurrence after their first episode. Nonoperative decompression could thus be suggested as the sole treatment for the first episode of volvulus. However, after the second episode it is probable that early planned surgery would improve outcome and reduce health-care consumption.
['Johansson|N|N|', 'Rosemar|A|A|', 'Angenete|E|E|0000-0001-9966-4904']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D015331:Cohort Studies D000072700:Conservative Treatment D013505:Digestive System Surgical Procedures D017558:Elective Surgical Procedures D004630:Emergencies D005260:Female D006801:Humans D045822:Intestinal Volvulus D008297:Male D008875:Middle Aged D009026:Mortality D012008:Recurrence D012189:Retrospective Studies D012810:Sigmoid Diseases D013548:Sweden D055815:Young Adult
recurrence Sigmoid volvulus surgery nonoperative decompression