Predictive Markers for Surgical Indication in Sigmoid Volvulus with Grade II Ischemia
Dimitrie Buşu, Vasile Sârbu, Mihaela Pundiche, Răzvan Cătălin Popescu, Daniel Ovidiu Costea, Ispas Viorel, Andrei Dumitru, Cristina Tocia, Ioana Popescu, Ispas Sorina, Nicoleta LeopaOriginal article, no. 3, 2025
Article DOI: 10.21614/chirurgia.3148
Background: Grade II ischemia in sigmoid volvulus presents challenges in surgical decision-making. This study compares outcomes between patients undergoing sigmoid resection during the first episode versus at recurrence.
Methods: A retrospective analysis of 63 patients with intraoperatively confirmed Grade II ischemia treated between 2018-2024 was performed. All underwent initial endoscopic decompression followed by surgical resection - either during the first episode (Group I, n=41) or at recurrence (Group II, n=22). Demographic, biochemical, and surgical outcomes were compared.
Results: Biochemical markers - including white blood cell count, CRP, D-dimer, serum lactate, and creatinine - were significantly elevated in recurrent cases (all p 0.001). Lower blood pH values were observed in recurrent cases (7.23 vs. 7.29, p 0.001) consistent with systemic acidosis. Operative time and intraoperative blood loss were higher in the recurrent group, and primary anastomosis was performed only in the first-episode group. Postoperative complications were more common in recurrent cases (31.8% vs. 12.2%, p=0.064), and length of stay was longer (8.64 vs. 6.32 days, p 0.001).
Conclusions: Delayed surgery at recurrence is associated with worsened inflammation, metabolic derangement, and higher surgical risk. Early surgery during the first episode offers better clinical outcomes.
Methods: A retrospective analysis of 63 patients with intraoperatively confirmed Grade II ischemia treated between 2018-2024 was performed. All underwent initial endoscopic decompression followed by surgical resection - either during the first episode (Group I, n=41) or at recurrence (Group II, n=22). Demographic, biochemical, and surgical outcomes were compared.
Results: Biochemical markers - including white blood cell count, CRP, D-dimer, serum lactate, and creatinine - were significantly elevated in recurrent cases (all p 0.001). Lower blood pH values were observed in recurrent cases (7.23 vs. 7.29, p 0.001) consistent with systemic acidosis. Operative time and intraoperative blood loss were higher in the recurrent group, and primary anastomosis was performed only in the first-episode group. Postoperative complications were more common in recurrent cases (31.8% vs. 12.2%, p=0.064), and length of stay was longer (8.64 vs. 6.32 days, p 0.001).
Conclusions: Delayed surgery at recurrence is associated with worsened inflammation, metabolic derangement, and higher surgical risk. Early surgery during the first episode offers better clinical outcomes.
Keywords: sigmoid volvulus, ischemia, endoscopic decompression, early surgery, inflammatory markers
