Comparative Outcomes of Primary Anastomosis Versus the Hartmann’s Procedure for Sigmoid Volvulus: A Systematic Review and Meta-Analysis

BACKGROUND: Sigmoid volvulus is the leading cause of large bowel obstruction in volvulus belt countries, involving twisting of the sigmoid colon around its mesentery. Possible surgical options include primary anastomosis or Hartmann’s procedure. This study aimed to assess the in-hospital results of resection and primary anastomosis (RPA) compared to Hartmann’s procedure (HP) in adult patients. METHODS: This systematic review and meta-analysis analyzed adult participants aged 18 and above with sigmoid volvulus who underwent sigmoid RPA or HP. The research involved observational studies, randomized controlled trials, and unrestricted English-only studies. Data was screened in Covidence and analyzed using SPSS 29v. RESULTS: Eighteen studies were included—seventeen cohort studies and one randomized controlled trial—comprising 4,473 patients (63.7% male, 36.3% female; mean age: 54.1 years). Overall mortality was higher with resection primary anastomosis than with Hartmann’s resection but was not statistically significant (OR: 0.64, 95% CI: 0.31–1.32, p = 0.20). In viable sigmoid volvulus, mortality was more common with RPA than HP but remained statistically insignificant (OR: 0.60, 95% CI: 0.33–1.00, p = 0.09). Mortality in gangrenous sigmoid volvulus was more common with Hartmann’s procedure than with primary anastomosis, though this was not statistically significant (OR: 0.80, 95% CI: 0.41-1.56; p = 0.51). Morbidity, measured by surgical site infection, was more common in primary anastomosis than in Hartmann’s procedure and not statistically significant (OR: 0.66, 95% CI: 0.34–1.28, p = 0.22). CONCLUSION: The research found no significant difference in mortality or morbidity rates between HP and RPA for both viable and gangrenous sigmoid volvulus. However, RPA showed a trend toward higher mortality, particularly in severe cases.