Tomonori Imakita, MD, Yutaka Suzuki, MDPhD, Hironori Ohdaira, PhD, Yasunobu Kobayashi, MD, Taigo Hata, MD, Mutsumi Kaji, MD, Mitsuyoshi Urashima, MDPhD. International University of Health and Welfare
Background: Sigmoid volvulus (SV) shows a high recurrence rate even after the correction of torsion using an intestinal endoscope. Intestinal resection is radical, but the most patients with SV are too old and poor physical condition to take operation under general anesthesia.
Objective: To assess whether percutaneous fixation of the sigmoid colon from the surface of the abdomen using an endoscope (endoscopically assisted percutaneous sigmoid fixation) can be performed safely and without adverse events, and whether it can prevent recurrence of sigmoid torsion.
Patients: SV patients with American Society of Anesthesiologists physical status classification ≥3 or Barthel index <30 were included. Patients with intestinal necrosis, who were unable to reposition, whereas who could take intestinal resection were excluded. As a result, eight patients were treated with CAPS.
Interventions: First, preparation of the intestinal tract was done. Under X-ray observation, the intestinal endoscope was inserted to the fixation site, and the puncture site was identified by transmitted illumination and finger pressure. An exploratory puncture was made with a 23-G needle under local anesthesia to decide the fixation site. A skin incision was made, and sigmoid colon fixation was performed using a two shot anchor. The procedure was repeated at 5-10 sites and complete.
Main Outcome Measurements: Perioperative adverse events; relapse within 12 months postoperative.
Results: Endoscopically-assisted percutaneous sigmoid fixation was carried out in eight cases. Median age was 72.5 years (25-75%): 59-78.5 years). ASA-PS classifications were class 2, 1 patient; class 3, 4 patients; and class 4, 3 patients. Median Barthel index was 10 (25-75%: 0-20). Median procedure time was 72.5 min (25-75%: 56-80 min), median time required for fixation was 16 min (25-75%: 15-21.5 min). Perioperative adverse events were only one case of subcutaneous emphysema. There were no cases of serious adverse events such as peritonitis, small intestine injury, intraabdominal abscess, or intestinal obstruction, and no cases of surgical wound infection. There were no cases of recurrence during the 1-year follow-up period. Three patients died, the result of aspiration pneumonia in two patients and senile decay in one patient. As these were all more than four months after the procedure, they were judged to be death from other illnesses having no direct relationship with the procedure.
Conclusion: CAPS was carried out safely and no recurrence was found over the long term.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94332
Program Number: P321
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster