Introduction: Gangrenous Sigmoid Volvulus is a life-threatening surgical emergency; this study investigated Hartman's Procedure vs Resection And Primary Anastomosis(RPA) In Gangrenous Sigmoid Volvulus.
Primary Objective: To compare outcomes of Hartman's procedure vs RPA in cases of a gangrenous Sigmoid Volvulus in terms of Duration of surgery, postoperative complications, Duration of hospital stay and mortality.
Methods: This study consists of 20 cases,This is a prospective observational study at the Dept. of General Surgery VIMSAR, BURLA, from May 2019 to May 2021.
Results: Out of 100 cases of sigmoid volvulus, 20 were gangrenous sigmoid volvulus which meets inclusion and exclusion criteria. The most common age group for gangrenous sigmoid volvulus in this study is between 60 to 70 years. Incidence in males is higher than in females in the Ratio of 3:1 in this study; around 60% of cases underwent Hartman's procedure rest of the patients underwent RPA; the mean duration of surgery for RPA is 3.463+/-0.354 SD and for Hartman's procedure is 2.86+/-0.336 SD, mean duration of hospital stay for RPA 9.625+/-2.065 SD This study's for Hartman's procedure is 5.917+/-1.505 SD in this st seen following RPA is 3 patients( 37.5% ). All were in shock during the presentation, mortality following Hartman's procedure was 1 patient (8.3%), and 8 patients had features of shock at presentation. Superficial surgical site infection(SSSI) is the most common surgical complication of both procedures in this study in the range 62.5%-66.67%.
Conclusions: In this study with this sample size, the procedure of choice for a gangrenous sigmoid volvulus would be Hartman's procedure because it is associated with less duration of surgery, less duration of hospital stay compared to RPA and are statistically significant, and anastomotic leak following RPA being dreaded complication and associated with high mortality. In such an emergency setting, sepsis control should be the primary focus for patients in a sub-optimal state. However, the patient may have to undergo second surgery( colostomy reversal) following Hartman's procedure which can be planned after better optimisation in an elective settings with minimal complication and better success rates than in emergency settings.
Key words: Gangrenous sigmoid Volvulus, Hartman's procedure, Resection and primary anastomosis (RPA)
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