Our Summary

This research paper is about the risks of leaks after a specific type of colon surgery, called sigmoidectomy, which is often required for a condition known as sigmoid volvulus. The researchers reviewed cases of patients who had this surgery at two hospitals in Israel between 2014 and 2020.

Out of 58 patients (mostly men, average age around 67), about 17% experienced leaks after their surgery. The study found that patients had a higher risk of leaks if they had previously undergone certain procedures multiple times, were over 80 years old, had their surgery done through an open operation (as opposed to a less invasive laparoscopic method), or had a higher ASA grade, which is a measure of how sick a patient is before surgery.

The researchers suggest that these high-risk patients might be better off having a different kind of surgery called a colostomy, which diverts the colon to an opening in the abdomen. If they do have the sigmoidectomy, they need to be well informed about the risks and monitored closely after surgery.

FAQs

  1. What is the risk of leaks after a sigmoidectomy operation?
  2. How does a patient’s age and previous medical history affect the risk of leaks after a sigmoidectomy?
  3. What alternatives are suggested for high-risk patients who require a sigmoidectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about sigmoidectomy is to closely follow all post-operative instructions, including taking prescribed medications, following a specific diet, and avoiding strenuous activities. It is important to attend all follow-up appointments with your healthcare provider to monitor for any signs of complications, such as leaks or infection. If you experience any unusual symptoms, such as severe abdominal pain, fever, or changes in bowel habits, contact your healthcare provider immediately. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can help promote healing and reduce the risk of complications after surgery.

Suitable For

Patients who are typically recommended sigmoidectomy are those with sigmoid volvulus, a condition where the sigmoid colon twists on itself, causing a blockage in the bowel. This condition is more common in older adults, particularly those over the age of 60, and is more common in men than women.

Patients who have recurrent episodes of sigmoid volvulus, have a history of multiple previous procedures on the colon, are over 80 years old, have a higher ASA grade indicating poor health before surgery, or are undergoing open surgery rather than laparoscopic surgery may be at a higher risk for complications such as leaks after sigmoidectomy. These patients may need to be closely monitored and may benefit from alternative surgical options such as a colostomy.

Overall, the decision to recommend sigmoidectomy for a patient will depend on their individual medical history, the severity of their condition, and their overall health status. It is important for patients to discuss the risks and benefits of the procedure with their healthcare provider to make an informed decision about their treatment.

Timeline

  • Before sigmoidectomy: The patient would likely be experiencing symptoms of sigmoid volvulus, such as abdominal pain, bloating, constipation, and possibly vomiting. They would undergo various tests and evaluations to confirm the diagnosis and determine the best course of treatment. Pre-operative preparations would be made, including fasting and bowel preparation.

  • During sigmoidectomy: The surgery would be performed to remove the affected portion of the sigmoid colon and reattach the remaining healthy sections. The patient would be under general anesthesia and the procedure could be done either through open surgery or laparoscopically.

  • After sigmoidectomy: The patient would typically stay in the hospital for a few days for monitoring and recovery. They would be given pain medication and antibiotics to prevent infection. They would gradually resume eating and drinking and start moving around to promote healing. Follow-up appointments would be scheduled to monitor their progress and address any complications.

  • Risk of leaks: Some patients may experience leaks at the site of the surgery, which can lead to serious complications such as infection or sepsis. High-risk patients, as identified by the study, may need to consider alternative surgical options or be closely monitored for signs of leaks post-operatively. Proper patient education and post-operative care are crucial in reducing the risk of leaks and promoting successful recovery.

What to Ask Your Doctor

  1. What is the purpose of a sigmoidectomy in my case?

  2. What are the potential risks and complications associated with sigmoidectomy?

  3. What factors could increase my risk of developing leaks after sigmoidectomy?

  4. Are there any alternative treatment options to sigmoidectomy that may be more suitable for me?

  5. How will my recovery process look like after sigmoidectomy?

  6. How will my post-operative care be managed to minimize the risk of leaks?

  7. What signs and symptoms should I watch out for that may indicate a leak after surgery?

  8. How often will I need follow-up appointments to monitor my progress after sigmoidectomy?

  9. Are there any lifestyle changes or precautions I should take after sigmoidectomy to reduce the risk of leaks?

  10. What is the success rate of sigmoidectomy in treating sigmoid volvulus, and what are the long-term outcomes I can expect?

Reference

Authors: Tankel J, Gilshtein H, Neymark M, Zuckerman M, Spira R, Yellinek S. Journal: Tech Coloproctol. 2021 Nov;25(11):1225-1231. doi: 10.1007/s10151-021-02508-6. Epub 2021 Sep 4. PMID: 34480672