The effects of endoscopic procedures and flatus tube application on early recurrence following endoscopic detorsion in sigmoid volvulus: Review of 792 patients.

Objectives: Endoscopic detorsion is the first therapeutic option with 80-90% success rates in uncomplicated sigmoid volvulus (SV). However, recurrence rate rises up to 75%, 13% of which occur in early period. In this study, we aimed to utilize the role of endoscopic procedures (rigid or flexible) and flatus tube application on early SV recurrence. Methodology: In Ataturk University, Faculty of Medicine, Research Hospital, Department of General Surgery, in a partial retrospective and prospective evaluation, early recurrence rates of 792 SV patients (72.8%) treated with endoscopic detorsion were evaluated. Results: In 58.5-year period, endoscopic detorsion was tried in 792 patients (rigid endoscopy in 351, while flexible endoscopy in 441) of total 1,088 SV cases. Among patients with successful endoscopic detorsion and viable bowel, early recurrence rates were 3.3% (9/274), 4.3% (11/254) and 18.1% (17/94) in rigid endoscopy with flatus tube application, flexible endoscopy with and without flatus tube application groups, respectively. Early recurrence rates were statistically similar between flatus tube-applied groups irrespectively of endoscopy technique (3.3% and 4.3%, in rigid and flexible endoscopy groups, respectively, P>0.05). However, early recurrence rate was significantly higher in flexible endoscopy without flatus tube application group when compared with that of rigid endoscopy and flexible endoscopy with flatus tube application groups (18.1% vs 3.3% and 18.1% vs 4.3%, respectively, P<0.001 in each). Conclusion: Early recurrence looks like independent from the kind of the endoscopic instruments in SV. Although flatus tubes may prevent early recurrence as long as their placement, early SV recurrence may occur in some patients following their removal.