title: Re-examining treatment strategies for sigmoid volvulus: An analysis of treatment and outcomes in Lilongwe, Malawi.
abstract: INTRODUCTION: Sigmoid volvulus is a common surgical emergency in many regions of the world, with significant morbidity and mortality. The aims of this study were to (a) summarize outcomes and (b) define a treatment algorithm for sigmoid volvulus in our setting.  EXPERIMENTAL: Five year (2003-2008) retrospective review of sigmoid volvulus cases at Kamuzu Central Hospital, in Lilongwe, Malawi.  RESULTS AND DISCUSSION: There were 239 cases of sigmoid volvulus identified. Cases were mostly seen in males (91.7%), with a median age of 50 (range 18-86). Gangrene was noted in 36.7% of cases. Mesosigmoidopexy (36%), Hartmann's procedure (33%), and resection and anastomosis (23%) were the most common procedures. There was seasonal variation with more cases seen in the harvest months of March and April. The major complications noted were recurrence (5 of 6 recurrences after mesosigmoidopexy / plasty) and anastomotic leakage after resection and anastomosis (2 in gangrenous, and 2 in non-gangrenous sigmoid volvulus).  CONCLUSIONS: Gangrenous sigmoid volvulus is best managed with Hartmann's procedure. Non-gangrenous sigmoid volvulus is best managed with resection and anastomosis, unless there are risk factors for anastomotic leakage, in which case the surgeon should consider mesosigmoidopexy with non-absorbable suture.
authors.affiliation: Department of Surgery, Univ. of North Carolina, 4050 Burnett-Womack Bldg, CB 7050, Chapel Hill, North Carolina 27599, USA.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Samuel
authors.forename: Adesola
authors.initials: A
authors.lastname: Akinkuotu
authors.forename: Nelson
authors.initials: N
authors.lastname: Msiska
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cairns
authors.forename: Arturo P
authors.initials: AP
authors.lastname: Muyco
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Charles