Surgical Management of Sigmoid Volvulus: A Retrospective Review of Six Cases with a Focus on the Sharon Operation

TL;DR

This study reviews six cases of sigmoid volvulus and shows that the Sharon operation is a safe, quick, and effective surgical option for older or high-risk patients.

Contribution

The study provides clinical evidence supporting the Sharon operation as a viable surgical option for recurrent sigmoid volvulus in high-risk patients.

Findings

The Sharon operation had a significantly shorter operative time compared to laparoscopic sigmoidectomy.

No recurrence of volvulus was observed during a median follow-up of 61 months.

The Sharon operation was safely performed in patients with advanced age and severe comorbidities.

Abstract

Sigmoid volvulus is a clinically significant cause of large bowel obstruction that occurs particularly in older patients with a reduced physical function. Although endoscopic detorsion is the first-line treatment, volvulus recurrence is common and often requires elective surgery. Despite various reports on the surgical procedures, the optimal approach remains controversial. The Sharon operation, first introduced in 1985, is a minimally invasive technique that avoids mobilization of the sigmoid colon via a small incision in the left lower quadrant. Although it offers several advantages, such as shorter operative time, minimal invasiveness, and favorable clinical outcomes, it remains underutilized, especially in Japan. We evaluated the clinical utility and indications of the Sharon operation in high-risk patients with recurrent sigmoid volvulus.

This retrospective study analyzed 6 patients who underwent surgery for sigmoid volvulus at our institution between 2015 and 2023. The median age was 82.5 years, and all patients had a prior history of volvulus. Four patients underwent elective surgery following successful endoscopic detorsion, and 2 underwent emergency surgery due to suspected bowel necrosis. Among the elective cases, 2 received laparoscopic sigmoidectomy and 2 underwent the Sharon operation. The Sharon operation group had a shorter operative time (mean 74 min) than the laparoscopic surgery group (mean 225.5 min), with minimal blood loss in both groups. The only postoperative complication was superficial surgical site infection (SSI) in 1 laparoscopic case. During a median follow-up period of 61 months, no recurrence was observed. We chose the Sharon operation preferentially for patients with advanced age, poor nutritional status, or severe comorbidities including cardiac dysfunction.

The Sharon operation is a safe and effective option for recurrent sigmoid volvulus, particularly in older patients or those with significant comorbidities. Considering its shorter operative time and minimal incision, it may be helpful in patients who are unsuitable for standard laparoscopic or open procedures. No recurrence was observed during long-term follow-up, suggesting a potentially curative outcome of the Sharon operation.

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