Techniques in Coloproctology

, Volume 23, Issue 7, pp 697–697 | Cite as

Comment on ‘Colopexy in sigmoid volvulus recurrence’

  • E. DisciEmail author

Dear Sir,

I read with interest the paper written by Atamanalp and Atamanalp [1], 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 [2]. The mortality, morbidity, and recurrence rates of this procedure are reported to be 5%, 21%, and 7%, respectively [3]. 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 [4]. 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 [1]. 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 [5]. Atamanalp and Atamanalp recommend placing multiple fixation sutures instead of a single one to hinder a recurrent turning [1]. 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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Conflict of interest

The author declares that she has no conflict of interest.

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This article does not contain any studies with human participants performed by any of the authors.

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  1. 1.
    Atamanalp SS, Atamanalp RS (2019) Sigmoid volvulus: avoiding recurrence. Tech Coloproctol 23:405–406CrossRefPubMedGoogle Scholar
  2. 2.
    Coron E (2016) Should we recommend PEC and when? Endosc Int Open 04:E742–E743CrossRefGoogle Scholar
  3. 3.
    Frank L, Moran A, Beaton C (2016) Use of percutaneous endoscopic colostomy (PEC) to treat sigmoid volvulus: a systematic review. Endosc Int Open 04:E737–E741CrossRefGoogle Scholar
  4. 4.
    Tin K, Sobani ZA, Anyadike N et al (2017) percutaneous endoscopic sigmoidopexy using T-fasteners for management of sigmoid volvulus. Int J Colorectal Dis 32:1073–1076CrossRefPubMedGoogle Scholar
  5. 5.
    Atamanalp SS (2019) Sigmoid volvulus: the first one thousand-case single center series in the world. Eur J Trauma Emerg Surg 45:175–176CrossRefPubMedGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of General Surgery, Faculty of MedicineAtaturk UniversityErzurumTurkey

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