Sigmoid volvulus without gangrenous: Primary anastomosis versus anatomosis in 2 times?

Sigmoid volvulus is frequent in Africa. Without gangrenous primary anastomosis and anatomosis in 2 times is controversial. Objectives: Our aims were to determine the frequency of sigmoid volvulus without gangrenous, to describe its signs and to analyze the outcomes according to the surgical procedures used. Methodology: A retrospective study (January 2000-December 2009) was carried out in the department of general surgery at the teaching hospital Gabriel Touré in Bamako (Mali). All the patients operated for sigmoid volvulus without gangre were included. The SV with intestinal perforation were not included. On the whole 138 patients were included and divided into 3 groups: Group 1: 35 patients having undergone a surgical untwisting follow by a sigmoidectomy in the 2nd time. Group 2: 4 patients having undergone an colostomy in urgency followed by an anatomosis in the 2nd time. Group 3: 99 patients having undergone a sigmoidectomy anastomosis in urgency (ideal colectomy). Results: They were 116 men (84.06%) and 22 women (15.94%). The mean age was 40.14 years. The triad of Von Wahl was present among 95 patients (68.84%). After standard x-ray 95 patients (68.84%) had the characteristic sign of VS. The mean duration of surgery was 50 mn for surgical untwisting; 100 mn for colostomy; 105 mn for colectomy anastomosis in emergency, and 90 mn for sigmoidectomy in 2nd. The outcomes were simple among 32 patients (91.45%) in group 1 against 93 patients (93.93%) in group 3. It did not have a statistical difference between these 2 groups (Test of Yates p=0.90). We had recorded 3 cases of wound infection, 4 cases of digestive fistula (2.90%). The Mortality was 2.17% it was 1 death in each group. These deaths occurred among patients of age higher than 70 years in with cardiac failure. The mean duration of hospitalization was 11.26 days (6-65 days). Conclusion: The sigmoid volvulus is a common surgical urgency. It requires an early diagnosis and treatment. Resection and anastomosis in emergency does not present an additional risk. © 2014 Springer-Verlag.