Clinical Outcomes of Patients with Gangrenous Sigmoid Volvulus After Resection and Primary Anastomosis or Hartmann’s Procedure at the University Teaching, Adult Hospital in Lusaka, Zambia

Abstract

Background

Sigmoid volvulus (SV), a condition in which the sigmoid colon twists around its mesentery, is the most common cause of intestinal obstruction in our institution and can lead to gangrene if not treated promptly. The study aimed to address the limited data on clinical outcomes for gangrenous SV in the country.

Methods

A prospective cohort study was conducted on 40 patients at the University Teaching Hospitals in Lusaka, Zambia between May 2024 and April 2025. Data was collected using a researcher-administered structured questionnaire. Patients were followed up for a minimum period of 30 days postoperatively. Univariate and multivariate analysis were carried out using R. A P value of < .05 at 95% confidence interval was considered significant.

Results

The results showed no significant differences in baseline characteristics such as age, body mass index, and blood pressure between the two groups. The median hospital stay was 9 days for the RPA group and 8 days for the Hartmann’s group, which was not a significant difference (p = .457). Postoperative complications occurred in 22.5% of all patients, with no significant difference between the resection and primary anastomosis (RPA) group (20%) and the Hartmann’s group (26.7%). Common complications included surgical site infections and stoma-related issues. An anastomotic leak occurred in 16% of patients who underwent primary anastomosis. Mortality was low and comparable between both groups (RPA: 8%; Hartmann’s: 6.7%).

Conclusions

RPA was the more frequently performed procedure and demonstrated similar outcomes to Hartmann’s in terms of complications, hospital stay, and mortality. These findings suggest that RPA can be safely performed in selected patients with gangrenous SV, especially where adequate surgical expertise and perioperative care are available.