Prospective laparoscopic assessment of sigmoid elongation: association with constipation and abdominal pain.

BACKGROUND: Constipation is a common gastrointestinal complaint affecting up to 14% of the adult population, with a higher prevalence in women and older individuals. Structural abnormalities such as dolichosigma—elongation of the sigmoid colon—have long been discussed as potential contributors, but prospective intraoperative data in unselected adult populations remain scarce. The absence of standardized anatomical reference values further complicates clinical interpretation. METHODS: In this prospective observational study, sigmoid length was measured intraoperatively under standardized laparoscopic conditions in consecutive adult patients undergoing minimally invasive abdominal surgery. Clinical data including demographic parameters, comorbidities, Wexner Constipation Score (WCS), self-reported constipation, and abdominal pain were recorded. Associations between sigmoid length and symptoms were analyzed, and a multivariable logistic regression model was performed to adjust for potential confounders (age, sex, BMI). RESULTS: A total of 178 patients were included. Mean sigmoid length was 30.5 ± 12.2 cm (range 10–120 cm). Constipation was present in 37.6% and was associated with longer sigmoid length (32.6 ± 12.9 cm vs. 29.2 ± 11.6 cm; p = 0.006) and higher WCS (11.5 ± 5.5 vs. 3.5 ± 3.3; p < 0.001). A statistically significant but modest correlation between sigmoid length and WCS was observed (r = 0.26; p < 0.001). Patients reporting abdominal pain also exhibited longer sigmoid segments (31.4 ± 12.5 cm vs. 27.4 ± 10.9 cm; p = 0.031). In multivariable analysis, sigmoid length remained independently associated with constipation (adjusted OR 1.03 per cm, 95% CI 1.01–1.06; p = 0.019). CONCLUSION: Sigmoid elongation is associated with increased prevalence of constipation symptoms and abdominal pain in an unselected surgical population. A sigmoid length of approximately ≥ 33–35 cm may represent a pragmatic anatomical reference associated with symptom burden rather than a diagnostic threshold. These findings support the concept of dolichosigma as part of an anatomic–functional continuum, although causal relationships cannot be inferred. Further studies integrating radiologic and functional assessments are warranted.