Trans-Pfannenstiel sigmoidectomy for sigmoid volvulus: description of a novel surgical technique and initial experience from a retrospective case series

Purpose: Sigmoid volvulus is a recurrent cause of large bowel obstruction that predominantly affects elderly and frail patients. After successful endoscopic detorsion, elective sigmoid resection is recommended to prevent recurrence. This study describes a new, trans-Pfannenstiel approach for sigmoidectomy and reports the initial clinical experience with this technique. Methods: This study was designed as a single-center retrospective case series. Adult patients surgically treated for sigmoid volvulus between 2024 and 2025 were included. All patients underwent successful endoscopic detorsion and decompression followed by planned surgical resection. The primary outcome was postoperative complications within 30 days. Surgical technique, perioperative outcomes and short-term follow-up were analyzed. Results: Eleven patients were included, with a median age of 71 years (IQR 51-79); five patients (45.4%) were classified as ASA III, and nine patients (63.6%) had experienced two or more previous episodes of volvulus. Median operative time was 105 min (IQR 90-125). No patient required postoperative intensive care or reoperation. Postoperative complications occurred in four patients (36.4%), with one Clavien-Dindo grade IIIa complication managed non-operatively with CT-guided percutaneous drainage. Median length of hospital stay was 6 days (IQR 5-6). Three patients (27.3%) required early readmission for medical complications (one Clavien-Dindo IIIa and two Clavien-Dindo II complications). No postoperative mortality or recurrence of sigmoid volvulus was observed during a median follow-up of 394 days (IQR 246-434). Conclusions: Trans-Pfannenstiel sigmoidectomy is a feasible, safe, and reproducible technique for the surgical management of sigmoid volvulus in selected patients. When performed after endoscopic decompression in a planned setting, it allows definitive treatment while limiting abdominal wall trauma in a fragile population.