title: Laparoscopic-assisted endoscopic sigmoidopexy: a new surgical option for sigmoid volvulus.
abstract: OBJECTIVE
  Sigmoid volvulus accounts for 5% of cases of large-bowel obstruction. Here, we present the development of a new minimally invasive treatment method that aims to reduce the complication rate of standard percutaneous endoscopic colostomy tube insertion and negate the need for prolonged anesthesia or colectomy.
  
  
  METHODS
  Six patients underwent laparoscopic-assisted endoscopic sigmoidopexy for recurrent sigmoid volvulus at a mean age of 80.5 years (range, 76-83). The volvulus was decompressed endoscopically before laparoscopic adhesiolysis and detorsion of the sigmoid. Finally, the sigmoid was approximated with the anterior abdominal wall, and 2 endoscopically placed percutaneous endoscopic colostomy tubes were inserted. Later, the external component of the percutaneous endoscopic colostomy tubes was removed, and the internal parts were passed by way of the rectum.
  
  
  RESULTS
  Each operation was completed successfully in a mean time of 69 minutes and with no intraoperative complication. The mean postoperative stay was 20 days (range, 4-54). At median follow-up of 10.8 months, all patients were tube free with no incidence of recurrent volvulus, inadvertent tube traction, or leak.
  
  
  CONCLUSIONS
  This preliminary report shows laparoscopic-assisted endoscopic sigmoidopexy to be a safe treatment modality for recurrent sigmoid volvulus. As such, it is particularly useful for elderly patients, for whom colectomy is a high-risk procedure.
authors.affiliation: Oxford Radcliffe Hospital Trust, Oxford, United Kingdom. alex.gordonweeks@gmail.com
authors.forename: Alex N
authors.initials: AN
authors.lastname: Gordon-Weeks
authors.forename: Bruno
authors.initials: B
authors.lastname: Lorenzi
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lim
authors.forename: Massimo
authors.initials: M
authors.lastname: Cristaldi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D012809:Colon, Sigmoid / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D045822:Intestinal Volvulus / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D012189:Retrospective Studies; D012810:Sigmoid Diseases / Q000601:surgery*; D016896:Treatment Outcome