Early Post-Operative Morbidities Following Early Versus Delayed Sigmoidectomy After Sigmoid Volvulus
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Date
2024-12-02
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Addis Ababa University
Abstract
Background—Sigmoid volvulus (SV) is characterized by the abnormal twisting of the sigmoid colon on its mesentery. It is the number one cause of acute LBO in Ethiopia. The incidence of SV varies among different regions. In Western countries, it accounts for 1-5% of all colonic obstructions, while in Ethiopia, it accounts for 58-69% of the LBO. It has a high recurrence rate of about 30 % to 80% and a significant mortality rate reaching 25–50% in some case series. According to the current practice guidelines, patients who present with uncomplicated SVare initially managed by endoscopic decompression followed by Sigmoidectomy. Sigmoidectomy carries inherent risks, including surgical site infections, anastomotic leaks, and cardio-respiratory complications. The study aimed to assess the early postoperative outcome of index and elective Sigmoidectomies.
Method:- A retrospective cross-sectional study was conducted by reviewing medical records of patients operated at three University-affiliated tertiary Hospitals in Addis Ababa. Data was collected through a structured questionnaire. The variables were coded and analyzed using SPSS version 26.
Result:-The analysis showed that the majority of our patients were from AA ( 76.9%) and the majority of them were male ( 84.3%) with an M: F ratio of 5:1. The median age of the sample patients was 53 years. During their sigmoid volvulus attacks, most of our patients presented more than 24 hours after the onset of symptoms (71.1%). Both elective and index sigmoidectomies had comparable frequencies, 51.2% & 48.8% respectively. And the majority of the cases were done via open Sigmoidectomies ( 95.9%). The median hospital stay after surgery was 6 days with 64.5% of the patients being discharged before 7th post-operative day. The most common post-operative morbidity was wound infection accounting for 31%. Younger patients (18-40years) had an 84.7% rate of being discharged from the hospital within a week of their surgery while the age groups from 41 to 70 and 71 to 90 had decreased discharge rate from the hospital within the first week of the surgery;( 57.3%,69.2% respectively ). Elective procedures had a shorter hospital stay with a one-week discharge rate of 77.4% while index procedures had a 50.8% discharge rate. And 30.8% of index sigmoidectomy patients stayed in the hospital for more than two weeks. The presence of diabetes was associated with a significant number of SSSI & wound dehiscence with 25% of diabetic patients 9 undergoing sigmoidectomy ending up with wound dehiscence & another 25% of the patients with SSSI as compared. The intraoperative finding of bowel edema was associated with an increased rate of hospital stay and anastomotic leak. Having index sigmoidectomy was associated with increased anastomotic leak rate and pulmonary complications.
Conclusion: Index sigmoidectomies were associated with a higher complication rate than elective sigmoidectomies.
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Morbidities Following Early Versus Delayed Sigmoidectomy