Sigmoidectomy

Sigmoidectomy is a surgical procedure that removes all or part of the sigmoid colon, with the goal of treating disease confined to that segment. After resection, bowel continuity can be restored with a primary anastomosis or, in some cases, a stoma may be created to divert fecal flow temporarily or permanently.

Indications for sigmoidal resection include diverticular disease with complications such as perforation or abscess, colorectal cancer located in the sigmoid colon, inflammatory bowel diseases affecting the sigmoid segment, and obstructive lesions. The procedure can be performed electively or emergently, depending on the underlying condition and patient stability.

Techniques and approaches vary. Sigmoidectomy can be done as an open operation, a laparoscopic procedure, or a robot-assisted operation. In cancer and other resections, the surgeon may perform a segmental sigmoidectomy with lymph node dissection, followed by a colorectal anastomosis between the remaining colon and the rectum. In patients with higher risk of anastomotic failure, or in certain inflammatory or contaminated settings, a diverting ileostomy or colostomy may be created to protect the anastomosis.

Intraoperative considerations include mobilization of the sigmoid colon, ligation of the inferior mesenteric vessels supplying the segment, and careful resection with adequate margins. The choice between primary anastomosis and a stoma depends on factors such as tissue quality, contamination, patient comorbidities, and the level of colorectal continuity preserved.

Postoperative care emphasizes pain control, early mobilization, gradual advancement of diet, and monitoring for complications such as anastomotic leak, infection, abscess, or ileus. Overall outcomes are favorable for appropriately selected patients, with varying risk based on indication and surgical approach.