Comment on ‘Colopexy in sigmoid volvulus recurrence’
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I read with interest the paper written by Atamanalp and Atamanalp , entitled ‘Sigmoid volvulus: avoiding recurrence’. The paper contains both basic treatment rules and lesser known clues for minimizing recurrence in sigmoid volvulus (SV). As a surgeon and an endoscopist, I want to discuss the role of colopexy in the treatment and recurrence of SV.
First of all, following a successful endoscopic decompression, percutaneous endoscopic colopexy (PEC) may be applied to reduce SV recurrence in selected frail and elderly patients . The mortality, morbidity, and recurrence rates of this procedure are reported to be 5%, 21%, and 7%, respectively . One of the major complications of PEC is peritonitis due to fecal leakage from the fixation tube application site, which is seen in 5% of the patients . Although the optimal PEC technique, including the number of fixation tubes has not yet been determined [2, 3, 4], the authors advise to use two or more fixation tubes instead of a single one to prevent a recurrent SV . It is clear that using multiple fixation tubes may increase the risk of leakage and peritonitis which is the major cause of death following PEC. In my opinion, a reduced risk of recurrence is not more important than an increased risk of mortality.
Second, a volvulus-reducing procedure such as colopexy may be used to reduce recurrence in selected well-conditioned and nonelderly patients with SV . Atamanalp and Atamanalp recommend placing multiple fixation sutures instead of a single one to hinder a recurrent turning . Both in PEC and surgical colopexy, what is the mechanism of recurrent volvulus despite a fixation point in the abdominal wall, obtained via fixation tube or suture? Can the sigmoid colon easily re-rotate despite this fixation point? In the event of a re-rotation, can two or more fixation tubes really prevent it?
I congratulate the authors for making very useful and pragmatic suggestions and await their comments.
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