Anatomy- and Function-Based Selection of the Extent of Surgery in the Surgical Treatment of Dolichosigma

Dolichosigma is a congenital or acquired elongation of the sigmoid colon and is one of the most common causes of chronic coprostasis, abdominal bloating, and abdominal pain syndrome in both children and adults. The prevalence of dolichosigma ranges from 15% to 27.6% in the general population, while it is identified as the etiological factor in 45–55% of patients with chronic colonic stasis. Surgical treatment is indicated when conservative therapy fails or when decompensation, sigmoid volvulus, or other complications occur. However, no universally accepted approach has yet been established for determining the optimal extent of surgery, including segmental resection, left hemicolectomy, subtotal colectomy, or colectomy with ileorectal anastomosis. This article presents a differential algorithm for selecting the appropriate surgical procedure based on both anatomical criteria (sigmoid colon length, mesosigmoid mobility, number of additional loops, and fixation abnormalities) and functional parameters. The results demonstrate that segmental resection is effective only in patients with isolated dolichosigma of limited length and preserved colonic motility, with unsatisfactory outcomes reported in only 12–18% of cases. In contrast, subtotal colectomy with ileorectal anastomosis is the preferred surgical option for patients with diffuse colonic inertia and decompensated disease.