Percutaneous sigmoid fixation for management of recurrent sigmoid volvulus: a randomized controlled clinical trial

Abstract

BACKGROUND: Sigmoid volvulus stands out as a frequent surgical emergency, particularly in older adults. Initial management centers on prompt detorsion of the affected colon segment, coupled with strategies to avoid future episodes. Preventing recurrence remains a persistent clinical challenge. Advances in endoscopic technology have positioned this modality as a pivotal tool in volvulus care, offering the dual advantage of therapeutic detorsion and diagnostic evaluation of predisposing factors. METHODS: We prospectively included all patients who presented to the emergency department at Zagazig University Hospital with recurrent sigmoid volvulus from August 2024 to August 2025. Sixty-six participants were randomized equally (n = 33 per group) to percutaneous endoscopic fixation or surgical intervention (control group: open or laparoscopic sigmoidopexy or sigmoidectomy under general anesthesia) using sealed envelopes with third-party-generated random assignments. The protocol received prospective institutional review board approval from Zagazig University Faculty of Medicine (IRB #633/1-Sep-2024) and was registered retrospectively on ClinicalTrials.gov in September 2025 (NCT07155304). The trial was conducted under the code of ethics of the World Medical Association (Declaration of Helsinki) for studies involving human subjects. And all participants provided written informed consent. Reporting followed CONSORT guidelines. RESULTS: Procedure-related complications included small bowel injury, sigmoid perforation, skin necrosis, pulmonary infection, intra-abdominal abscess, peritonitis, fecal fistula, recurrence, and mortality. In the percutaneous endoscopic fixation group, rates were 1 (3%) for small bowel injury, 1 (3%) for sigmoid perforation, 2 (6%) for skin necrosis, 3 (9%) for pulmonary infection, 3 (9%) for abscess, 3 (9%) for peritonitis, 0 (0%) for fistula, 1 (3%) for recurrence, and 0 (0%) for mortality. Corresponding figures in the surgical cohort group 2 (6%), 0 (0%), 4 (12%), 5 (15%), 4 (12%), 4 (12%), 4 (12%), 1 (3%), and 3 (9%). Quality-of-life assessments categorized outcomes as excellent, good, or poor: endoscopic group, 24 (73%), 5 (15%), 4 (12%); surgical group, 17 (52%), 11 (33%), 5 (15%). CONCLUSION: Percutaneous endoscopic fixation provides a lower-morbidity and mortality alternative approach for patients with recurrent sigmoid volvulus without the need for general anesthesia.