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Objective: To evaluate the effectiveness of resection and primary anastomosis (RPA) and RPA with modified foramen colostomy in case of sigmoid twist. Place and Duration: In the Surgical Unit-II of Nishtar Hospital, Multan for one-year duration from August 2019 to August 2020. Methods: 77 patients with acute sigmoid twist were treated. A total of 47 patients underwent RPA or RPA with an orifice modified colostomy. Twenty-five patients received RPA (Group A) and the remaining 22 patients received RPA with Modified Bore Colostomy (Group B). The clinical course and postoperative complications of both groups were compared. Results: Mean hospital stay, wound infection, and mortality did not differ significantly between the groups. The rate of superficial wound infections was higher in group A (32% vs 9.1%). Anastomotic leakage was observed only in group A, with a frequency of 6.3%. The difference was numerically impressive but statistically insignificant. Conclusion: RPA with Modified Bore Colostomy produces satisfactory results. It is easy to implement and may become the method of choice in patients with sigmoid volvulus. More research is needed to further establish its role in treating sigmoid volvulus. Key words: Anastomosis; Primary resection; Surgical technique