A 68-year-old yellow raced Japanese female had a chronic history of sigmoid volvulus with persistent constipation due to paralysis of the sigmoid colon. Sigmoidectomy is considered the best therapy for such conditions. The possibility of malignancy and other abdominal diseases was eliminated by performing colonoscopy, abdominal computed tomography, and barium enema. The day before the operation we prepared the colon using 1800 ml isotonic magnesium citrate.
After inducing general anesthesia, the patient was placed in the lithotomy position. The first port (10 mm) was placed near the umbilicus, the second (5 mm) in the left upper quadrant, the third (5 mm) in the right middle flank, and the last (5 mm) in the right lower quadrant (Figure 1). After inserting the trocar, the colonoscope was inserted into the splenic flexure through the anal aperture under colonoscopic and laparoscopic monitoring. The length was sufficient to prevent the recurrence of sigmoid volvulus, which was estimated to be 40 cm in this patient. Intracolonic lavage was performed with polyvinylpyrrolidone iodine, using a colonoscope. First, an 18 G needle was inserted into the sigmoid colon to the oral cutting point. Through this opening, a 2-0 nylon suture was inserted into the colon. It was retrieved using snare forceps, and the colonoscope was removed from the anus. The anvil was attached to it, allowing it to be pulled back to the sigmoid colon (Figures 2 and 3). The linear stapler was used to cut the anal end of the anvil and the end of the sigmoid colon (Figure 4). The mesosigmoid colon was cut using laparoscopic coagulating shears. Before anastomosis, the anvil was cleaned with iodine. The rest of the colon was anastomosed from the oral side of the anvil to the anal side of the shaft. Finally, the resected sigmoid colon was removed through the umbilical incision. An incision of less than 2 cm was adequate.
Two days after surgery, the patient started eating and her body temperature normalized. The following day, the patient walked comfortably with only slight abdominal pain. Her bowel function improved compared with its preoperative status. One week after surgery, the operative scar healed completely (Figure 5) and the patient was discharged with no complications.