Sigmoid volvulus (SV) is an abdominal emergency for which the optimal management strategy remains debated. Endoscopic detorsion (ED) offers an effective alternative to immediate surgery, allowing decompression and improving operative conditions. This study aimed to assess the outcomes of ED, identify predictors of its success, and evaluate its impact on surgical strategy and postoperative results.

This retrospective study spanned 15 years (2005–2020) and included patients presenting with uncomplicated SV who underwent an attempt of ED. Successful detorsion was followed by elective resection, whereas emergency surgery was performed in cases of ED failure or complicated recurrence. Clinical, radiological, and operative data were analyzed. Predictive factors for ED success were assessed using statistical analysis (SPSS, Chi-square test, p < 0,05).

Thirty patients were included (mean age 64.3 ± 11 years), with a male predominance (70%). All presented with signs of distal bowel obstruction, including abdominal distension (100%), diffuse abdominal pain (90%), and cessation of stool and gas passage (87%). Diagnosis was confirmed by imaging in all cases.

ED successfully relieved obstruction in 75% of patients (n = 23). The mean interval before elective surgery was 22 days. Among these patients, 90% underwent scheduled sigmoidectomy with single-stage primary anastomosis, performed under optimal conditions and associated with low morbidity and no mortality.

Conversely, 7 patients (25%) required emergency surgery due to initial ED failure or complicated recurrence. Most underwent resection with stoma formation (Bouilly-Volkmann in 88%, Hartmann’s procedure in 12%). This group showed higher postoperative morbidity (30%) and included one death.

Predictive factors of ED success included consultation delay < 72 hours, endoscopic intervention < 77 hours, caecal diameter < 10 cm, typical radiographic appearance, and history of subocclusive episodes (p < 0.001). Conversely, prior abdominal surgery, caecal diameter > 10 cm, and delayed management (> 77 hours) were significantly associated with ED failure. Successful ED significantly increased the likelihood of single-stage surgery with primary anastomosis (p = 0.025).

Endoscopic detorsion represents a key step in the management of uncomplicated SV. It enhances operative conditions, reduces the need for emergency surgery, and facilitates elective resection with primary anastomosis, ultimately improving prognosis. Early identification of patients at high risk of ED failure is essential to guide optimal therapeutic strategy and reduce morbidity and mortality.