Sigmoid colectomy is indicated for:

• Sigmoid colon cancer: Tumors in the sigmoid colon, often detected via colonoscopy.
• Diverticulitis: Recurrent or complicated cases (e.g., abscess, perforation, fistula) unresponsive to medical therapy.
• Sigmoid volvulus: Twisting of the sigmoid colon causing obstruction, common in older adults.
• Inflammatory bowel disease (IBD): Crohn’s disease or ulcerative colitis with sigmoid involvement.
• Benign conditions: Large polyps, strictures, or trauma causing obstruction or bleeding.

The procedure aims to remove diseased tissue, prevent complications (e.g., cancer spread, perforation), and restore bowel function.

The procedure is tailored to the condition, disease extent, and patient health:

1. Before Surgery Evaluation:
   
   • Diagnosis:
     
     • Colonoscopy with biopsy confirms cancer, diverticulitis, or other pathology.
     • CT scan assesses disease extent, complications (e.g., abscess), or metastasis.
     • Blood tests measure CEA (cancer marker), inflammation (CRP), and surgical fitness.
   • Bowel preparation (laxatives, enemas) clears the colon 1–2 days prior.
   • Antibiotics (e.g., metronidazole, ciprofloxacin) are given for infection or prophylaxis.
   • Patients are counseled on potential stoma creation (temporary or permanent) and recovery.
2. Surgical Techniques:
   
   • Open Sigmoid Colectomy:
     
     • Performed under general anesthesia, lasting 2–4 hours.
     • A midline abdominal incision provides access to the sigmoid colon.
     • The sigmoid colon is mobilized by dividing its blood supply (inferior mesenteric artery branches) and surrounding attachments.
     • The diseased segment is resected, ensuring clear margins (5 cm for cancer).
     • The descending colon is anastomosed to the rectum using sutures or a stapling device.
     • A temporary loop ileostomy or colostomy may be created to protect the anastomosis, especially in emergency cases or high-risk patients.
   • Laparoscopic Sigmoid Colectomy:
     
     • Minimally invasive, using 4–5 small incisions, a laparoscope, and instruments.
     • Suitable for elective cases (e.g., early-stage cancer, diverticulitis), offering less pain and faster recovery.
     • Takes 2–4 hours; conversion to open surgery is possible if complications arise.
   • Robotic-Assisted Sigmoid Colectomy:
     
     • Uses robotic systems (e.g., da Vinci) for enhanced precision, particularly in the pelvis.
     • More expensive, available in centers like Apollo or Medanta.
   • Emergency Sigmoid Colectomy:
     
     • For perforation, obstruction, or volvulus, often requiring a Hartmann’s procedure: resection with an end colostomy and rectal stump closure, reversed later.
3. After Surgery:
   
   • ICU monitoring for 1–2 days manages pain, fluids, and bowel function.
   • Hospital stay: 5–10 days (open), 3–7 days (laparoscopic/robotic).
   • Pathology reports guide adjuvant therapy (e.g., chemotherapy for cancer).
   • Stoma care training is provided if applicable.