Laparoscopic plication and retroperitonealization of the sigmoid colon in frail patients with volvulus: A revived surgical option with lessons from Africa informing 2 cases in the Netherlands

Abstract

Although sigmoid volvulus is not common in Western countries, its prevalence is increasing with the ageing population. The management of older, frail patients with sigmoid volvulus and multiple comorbidities is challenging. Conservative treatment is preferred but is associated with a high recurrence rate.

Based on insights from endemic regions, nonresectional surgical approaches are gaining traction. We propose a minimally invasive, nonresectional technique designed to mitigate the elevated risks associated with frail patients: laparoscopic plication and retroperitonealization of the sigmoid colon (PROSC).

Two older adults with extensive comorbidities underwent laparoscopic PROSC for persistent or recurrent sigmoid volvulus. There were no procedural or postoperative complications. No recurrent volvulus, constipation, or infection was reported at a 12-month follow-up evaluation.

These results show that laparoscopic PROSC could be an attractive and safe minimally invasive alternative technique for treating older, frail patients with (recurrent) sigmoid volvulus. The technique may be a superior alternative for treating nongangrenous sigmoid volvulus.