Laparoscopic plication and retroperitonealization of the sigmoid colon, a revived surgical option for volvulus in frail patients: Lessons from Africa informing 2 cases managed in the Netherlands

Abstract

[Accepted Case Report]

Although sigmoid volvulus is not common in Western countries, the prevalence is increasing with the aging population. Management of sigmoid volvulus in elder, frail patients with multiple comorbidities is challenging. Conservative treatment is preferred but has a high recurrence rate.

Based on reversed learning from endemic regions nonresectional operative procedures are increasingly implemented. We propose a minimally invasive nonresectional technique, avoiding the potential high risk in frail patients: Laparoscopic Plication and Retroperitonealization Of the Sigmoid Colon (PROSC).

Two elderly patients with extensive comorbidities underwent Laparoscopic PROSC for persistent or recurrent sigmoid volvulus. There were no procedural nor postoperative complications. No recurrent volvulus, constipation or infection were reported at 12 months follow up.

These results show that Laparoscopic PROSC could be an attractive and safe minimally invasive alternative technique in the elder, frail patient with (recurrent) volvulus. It may be a superior alternative modality of surgery for the non-gangrenous sigmoid volvulus.