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Techniques in Coloproctology

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

Comment on ‘Colopexy in sigmoid volvulus recurrence’

  • E. DisciEmail author
Correspondence

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.

Notes

Compliance with ethical standards

Conflict of interest

The author declares that she has no conflict of interest.

Ethical approval

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

Informed consent

For this form of study, formal consent is not required.

References

  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

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

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

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