INTRODUCTION:After nonoperative decompression of acute sigmoid volvulus, definitive surgery is necessary because of the high risk of recurrence. However, the optimal surgical technique for this purpose has not been determined.METHODS:We studied 106 consecutive patients (mean age, 60.9 (range, 26‐93) years) who underwent emergency resection for acute sigmoid volvulus between 1992 and 2000. No patient underwent preoperative decompression techniques, had the bowel prepared, or received on‐table lavage.RESULTS:Depending on the patient's condition and the surgeon's preference, either primary anastomosis (57 cases) or Hartmann's procedure (49 cases) was performed. The overall mortality rate was 6.6 percent (7/106). The presence of a gangrenous bowel increased the mortality rate to 11 percent. Wound infections were documented in 8 and 12 cases, intra‐abdominal abscess occurred in 1 and 7 cases, and subsequent surgery was required in 6 and 5 patients who underwent primary anastomosis and Hartmann's procedure, respectively. There were four cases of anastomotic dehiscence (7 percent) and two cases of stoma revisions (4 percent). The median length of stay was eight days for both those who underwent primary anastomosis (range, 3‐27 days) and those who underwent Hartmann's procedure (range, 5‐29 days).CONCLUSION:Emergent primary resection of the acute sigmoid volvulus with or without anastomosis is adequate treatment for this emergent surgical problem.