Comparison of recurrence and mortality rates between resection and non-resection surgical methods for treating sigmoid volvulus: a systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis aims to compare the recurrence and mortality rates of resection versus non-resection surgery for sigmoid volvulus (SV), a condition requiring a balance between recurrence prevention and mortality minimization.

METHODS

A comprehensive search of PubMed, EMBASE, Web of Science, and Cochrane Library identified studies comparing resection and non-resection surgeries for SV. Primary outcomes included recurrence rates, and secondary outcomes included mortality rates. Randomed effects models were used to calculate pooled effect sizes.

RESULTS

A total of 28 nonrandomized studies, comprising 837 resection and 660 non-resection patients, were included. Resection significantly reduced recurrence (RR: 0.12, 95% CI: 0.06-0.24, P < 0.001) with an NNT of 6 (95% CI: 5.7-7.0) but it was associated with increased mortality (RR: 1.69, 95% CI: 1.17-2.44, P = 0.005, NNH = 17 [95% CI: 11.1-33.3]). Subgroup analysis excluding gangrenous sigmoid patients showed resection effectively prevented recurrence (RR: 0.20, 95% CI: 0.08-0.50, P < 0.001, NNT = 9 [95% CI: 6.2-13.7]) with no significant mortality difference (RR: 1.12, 95% CI: 0.53-2.37, P = 0.760). Similar results were observed in sensitivity analyses excluding studies published before 1990, analyses limited to prospective studies, and when comparing resection with specific non-resection procedures.

CONCLUSIONS

Resection is effective in preventing SV recurrence, with no significant mortality increase in patients with virable colon, supporting its use in suitable patients. Future research should optimize patient selection and perioperative care.