From the Guidelines
For patients with colonic redundancy, particularly those with a history of sigmoid volvulus, sigmoid colectomy is strongly recommended to prevent recurrent volvulus, with the procedure ideally performed as early as possible, even during the index admission. This approach is based on the high recurrence rate of sigmoid volvulus after endoscopic decompression, ranging from 45 to 71% 1. The mortality rate after conservative treatment also varies significantly, between 9% and 36% 1, highlighting the importance of surgical intervention to prevent such outcomes.
Key Considerations
- The entire length of the redundant colon should be removed to effectively prevent recurrent volvulus 1.
- Sigmoid colectomy has been shown to result in low morbidity and mortality, in the range of 0–12% 1, making it a viable option for patients.
- The decision between laparotomy and laparoscopy should be based on the surgeon's comfort and expertise 1.
- Stoma creation is typically not required in non-emergency settings 1.
Management Approach
- Dietary modifications and lifestyle changes are initial steps in managing colonic redundancy, but for those with a history of sigmoid volvulus, surgical intervention is often necessary.
- The high risk of recurrence and potential for significant morbidity and mortality with conservative management support the recommendation for early sigmoid colectomy 1.
- Post-operative care should focus on preventing complications and ensuring the patient can manage any remaining portions of their colon effectively.
From the Research
Definition and Causes of Colonic Redundancy
- Colonic redundancy is a condition where the colon becomes redundant or twisted, leading to mechanical dysfunction and symptoms such as food retention and aspiration 2, 3, 4.
- This condition can occur after esophageal replacement by colonic interposition, and is often caused by redundancy in the colonic graft 2, 3, 4.
Symptoms and Diagnosis
- Symptoms of colonic redundancy include dysphagia, regurgitation, pneumonia, and chest pain 4.
- Diagnosis is typically made through preoperative work-up and surgical evaluation 2, 3, 4.
Treatment Options
- Surgical correction is often necessary to improve quality of life and prevent complications such as aspiration 2, 3, 4.
- Techniques for correcting colonic redundancy include resection of the redundant colon, side-to-side colocolic anastomosis, and gastric resection or diversion of bile and acid 2, 3, 4.
- Lubiprostone, a chloride channel activator, may also be used to treat chronic constipation, which can be a symptom of colonic redundancy 5, 6.