Introduction

The incidence of sigmoid volvulus shows marked geographical variation. In East Scotland an incidence of 1.7 per 100,000 has been reported [1] whilst in the population of rural Ghana the incidence is as high as 12 per 100,000 [2]. In India approximately 30 per cent of acute intestinal obstructions are secondary to volvulus of the sigmoid colon [3].

Non-operative approaches to management of sigmoid volvulus such as sigmoidoscopic and colonoscopic decompression have been described [4,5] but recurrence rates are high [6]. Therefore resectional surgery either with a primary anastomosis or a Hartmann's procedure has been the standard management [7,8].

This article describes a non-resectional definitive alternative, mesosigmoplasty which can be performed in the acute and elective setting.

Operative technique

Mesosigmoplasty is performed under general anaesthesia via a left lower paramedian incision usually [9] but our preference is to utilise a lower midline incision. The distended sigmoid colon is delivered through the incision (Figure 1) following detorsion if required.

Figure 1

In the initial description of the technique by Tiwary and Prasad the peritoneum of the mesocolon is incised vertically on its medial and lateral aspect [9]. We prefer after confirmation of bowel viability to create a window within the mesosigmoid from its root to its apex (Figure 2) preserving its blood supply.

Figure 2

Vicryl stay sutures are placed at each end of the transverse axis of the window (Figure 2) which is then closed transversely with a continuous Vicryl 2/0 (Figure 3).

Figure 3

This technique effectively shortens and broadens the mesentery of the sigmoid colon (Figure 4) thus avoiding future volvulus. Abdominal mass closure is performed with loop Nylon and the skin is sutured with a subcuticular Vicryl 3/0.

Figure 4

Conclusion

When volvulus causes irreversible ischaemia resectional surgery is required. However, a variety of operative and non-operative options exist for the management of the viable sigmoid colon. Mesosigmoplasty has become the operation of first choice for non-ischaemic sigmoid volvulus in our unit because of its technical simplicity, low morbidity and low mortality [10,11].

Literature

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