LAPAROSCOPIC SIGMOIDOPEXY FOR SIGMOID VOLVULUS
| Discussion in 'All Categories' started by Padmaraju - Apr 6th, 2025 6:57 pm. | |
Padmaraju
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Sir, please demonstrate how to do sigmoidopexy for sigmoid volvulus. kindly upload the videos |
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re: LAPAROSCOPIC SIGMOIDOPEXY FOR SIGMOID VOLVULUS
by Dr B S Bhalla -
Nov 19th, 2025
12:02 pm
#1
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Dr B S Bhalla
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Laparoscopic Sigmoidopexy — Step-by-Step Surgical Demonstration ⸻ 1. Patient & Position • Supine position • Both arms tucked • Trendelenburg with slight left tilt • Foley + NG tube if needed • Prophylactic antibiotics as per protocol ⸻ 2. Port Placement (Your usual 5 mm working ports) • Supraumbilical camera port (5 or 10 mm based on your preference) • Left lower quadrant 5 mm port • Right lower quadrant 5 mm port • Optional: Right upper quadrant 5 mm port if colon is massively dilated ⸻ 3. Initial Assessment • Identify: • Twisted segment • Dilated sigmoid loop • Viability (color, mesenteric pulsations, peristalsis) If doubt in viability → sigmoidopexy is contraindicated. ⸻ 4. Derotation of the Volvulus • Hold the cephalad limb with your left hand • Hold the caudad limb with your right hand • Rotate anticlockwise (most common volvulus rotates clockwise) Gentle pressure only — avoid serosal tears. Once derotated, confirm: • Pink coloration • Mesenteric pulsation • No gangrene • No mesenteric tears ⸻ 5. Assess Mesentery The culprit is usually: • A long, redundant, mobile sigmoid mesentery • A narrow base (mesenteric root predisposition) Goal of sigmoidopexy: Fix the sigmoid colon to prevent retwisting. ⸻ ???? 6. Sigmoidopexy Technique (Fixation Steps) Fixation Points Fix the descending colon and sigmoid colon to: • Left lateral abdominal wall • Peritoneum over the psoas • White line of Toldt Technique Use non-absorbable suture (Prolene 2-0 or 0): 1. Start by aligning the sigmoid colon without tension. 2. Take a seromuscular bite on the sigmoid colon (avoid full thickness). 3. Take a counter bite on the lateral peritoneum / abdominal wall. 4. Place 4–6 interrupted sutures, spaced 3–4 cm apart. Common fixation pattern: • 1–2 sutures at descending colon • 2–3 sutures on sigmoid loop • 1–2 sutures near pelvic brim Goal: eliminate the mobility that allows volvulus. ⸻ 7. Avoid These Errors • Do not take full-thickness colonic bites (risk of delayed leak). • Do not fix sigmoid under tension. • Do not fix too near the mesenteric border (risk of ischemia). • Avoid using barbed sutures here; Prolene gives rigid fixation. ⸻ 8. Check for: • No twisting left • Sigmoid straightened • No crossing loops • Good blood flow • No tension on fixation sutures ⸻ 9. Optional — Mesosigmoidoplasty If mesentery is excessively long: • Take two rows of sutures reducing mesenteric redundancy. • Do not compromise vessels. ⸻ 10. Closure • Irrigate if needed • Remove ports under vision • Standard 5 mm port closure principles ⸻ ???? Postoperative Care • Early ambulation • Fluids once bowel sounds return • Observe for: • Recurrent distension • Pain • Fever |