Sigmoid Colectomy — Procedure Guide, Recovery & Risks | MyMedicPlus

Sigmoid colectomy resects the sigmoid colon (S-shaped section between the descending colon and rectum) with restoration of bowel continuity via a colorectal anastomosis. It is performed laparoscopically (preferred) or open and includes adequate proximal and distal margins with lymph node clearance for cancer.

Common indications include recurrent or complicated diverticulitis (abscess, fistula, stricture, perforation), sigmoid colon cancer, sigmoid volvulus (recurrent), large polyps not removable endoscopically, Crohn's colitis limited to the sigmoid, and ischemic colitis causing stricture or gangrene.

Under general anaesthesia with epidural analgesia, laparoscopic ports placed; lateral-to-medial or medial-to-lateral approach mobilizes the sigmoid colon; inferior mesenteric artery ligated at its origin for cancer; sigmoid divided above and below disease; circular-stapled end-to-end colorectal anastomosis fashioned; air-leak tested.

Enhanced recovery after surgery (ERAS) protocols allow clear fluids day 1 and diet by day 2. Hospital stay is 3-5 days for laparoscopic versus 5-7 days for open. Bowel function returns in 2-4 days. Light activity resumes at 2 weeks; return to work at 3-4 weeks; full activity at 6 weeks.

Anastomotic leak occurs in 3-5% and may require temporary stoma formation. Wound infection (laparoscopic 3%, open 10%), ureteral injury below 1%, pelvic nerve injury causing bladder or sexual dysfunction, ileus (prolonged in 5-10%), and incisional hernia (open 10-15%) are recognized risks.

Laparoscopic sigmoid colectomy reduces hospital stay by 1-2 days and returns to work by 1-2 weeks compared to open surgery. Diverticulitis recurrence is below 5% after resection. 5-year survival for Stage I-II sigmoid colon cancer exceeds 80-90% with adequate oncologic resection.