Primary Anastomosis versus Hartmann’s Procedure in the Management of Sigmoid Volvulus in the General Surgery Department of Ignace Deen National Hospital, Conakry University Hospital

Introduction: Sigmoid volvulus is a common cause of acute intestinal obstruction in several African settings. When surgical treatment is required, the choice between sigmoid colectomy with primary colorectal anastomosis and Hartmann’s procedure depends on the patient’s general condition and intraoperative findings. The aim of this study was to compare the indications and short-term outcomes of these two procedures in patients operated on for sigmoid volvulus in a resource-limited setting. Materials and Methods: This was a prospective, non-randomized observational comparative study conducted over 18 months, from January 1, 2024, to June 30, 2025, in the General Surgery Department of Ignace Deen National Hospital-Conakry University Hospital. All consecutive patients admitted and operated on for sigmoid volvulus during the study period were included. The choice between primary anastomosis and Hartmann’s procedure was made intraoperatively according to bowel viability, the presence of necrosis or inflammatory changes, tissue quality, and the patient’s general condition. Sociodemographic, clinical, paraclinical, therapeutic, and postoperative variables were analyzed. Results: Among 1094 emergency surgical procedures performed during the study period, 112 patients with sigmoid volvulus underwent surgery. Primary anastomosis was performed in 80 patients (71.4%), whereas Hartmann’s procedure was performed in 32 patients (28.6%). The mean age was 49.5 years (range, 7 - 80 years), and 72 patients (64.3%) were male. The mean time from symptom onset to consultation was 5.0 days. Fifty-four percent of patients were referred from another healthcare facility. All patients underwent laboratory investigations and plain abdominal radiography. Abdominopelvic CT and MRI were not available in the emergency setting. The mean time from admission to surgery was 13.8 hours. Primary anastomosis was mainly selected when the bowel was viable and tissue quality was considered suitable, whereas Hartmann’s procedure was mainly performed in the presence of necrosis, extensive inflammatory changes, or other unfavorable intraoperative findings. The mean hospital stay was 11.5 days after primary anastomosis and 16.9 days after Hartmann’s procedure. Overall, 93 patients (83.0%) had an uncomplicated postoperative course, while 19 (17.0%) developed complications. Twelve patients died (10.7%): 8 (10.0%) in the primary-anastomosis group and 4 (12.5%) in the Hartmann group. Because the procedures were selected according to