Is sigmoidopexy still used for sigmoid volvulus caused by a redundant sigmoid colon?

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Last updated: October 13, 2026 • View editorial policy

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Sigmoidopexy Should Be Avoided for Definitive Treatment of Sigmoid Volvulus

Non-resectional operative procedures including sigmoidopexy are inferior to sigmoid colectomy for preventing recurrent volvulus and should be avoided 1. The 2023 WSES consensus guidelines provide a strong recommendation (Grade 1C) against using sigmoidopexy as definitive treatment for sigmoid volvulus caused by redundant sigmoid colon.

The Evidence Against Sigmoidopexy

While one older series by Bhatnagar and Sharma reported no recurrences in 84 patients after extraperitoneal sigmoid fixation, more contemporary data reveals a 29-36% recurrence rate after sigmoidopexy 1. This unacceptably high failure rate makes it an obsolete technique for most patients.

The recurrence rates tell the story clearly:

  • Sigmoidopexy: 29-36% recurrence
  • Sigmoid colectomy: effectively prevents recurrence (the gold standard)
  • Simple detorsion alone: 18-48% recurrence with 30-35% morbidity and 11-15% mortality 1

The Current Standard of Care

Sigmoid colectomy removing the entire redundant colon segment is the definitive treatment 1. After successful endoscopic decompression, elective sigmoid resection should be performed during the index admission whenever possible, as recurrence rates without resection range from 45-71% 1.

The non-urgent sigmoid resection carries low morbidity and mortality (0-12%), making it far superior to repeated episodes of volvulus or emergency surgery 1.

The Only Exception: Percutaneous Endoscopic Sigmoidopexy

Endoscopic fixation techniques (percutaneous endoscopic colostomy/sigmoidopexy) may be considered ONLY in highly selected patients who are prohibitively high-risk for operative intervention 1. This is a weak recommendation (Grade 2C) reserved for:

  • Elderly patients with severe comorbidities (ASA ≥3)
  • Patients with Barthel index <30 indicating severe functional impairment
  • Those who refuse surgery despite counseling

Recent research shows percutaneous endoscopic sigmoidopexy can prevent recurrence in carefully selected inoperable patients 2, 3, with one series of 15 patients showing no recurrences during median 10-month follow-up 2. However, this remains a salvage option, not standard practice.

Critical Pitfalls to Avoid

  1. Do not perform open surgical sigmoidopexy - it has the morbidity of surgery without the efficacy of resection
  2. Do not delay definitive resection - recurrence probability is 63% at 3 months, 47% at 6 months after conservative management alone 1
  3. Do not use sigmoidopexy in pediatric cases - one recent case report showed postoperative complications including adhesive small bowel obstruction after sigmoidopexy in a 14-year-old, highlighting the inadequacy of fixation alone 4

The Algorithm

For viable sigmoid volvulus after successful endoscopic decompression:

  • Surgical candidate → Sigmoid colectomy during index admission
  • Prohibitive surgical risk (ASA ≥3, severe frailty, refuses surgery) → Consider percutaneous endoscopic sigmoidopexy as salvage option
  • Never → Open surgical sigmoidopexy or mesosigmoidoplasty

Bottom line: Sigmoidopexy as an open surgical procedure is obsolete and should not be used 1. The only contemporary role for any fixation technique is percutaneous endoscopic sigmoidopexy in patients too frail for definitive resection.

References

1
Guideline

wses consensus guidelines on sigmoid volvulus management.

World Journal of Emergency Surgery, 2023

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