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Objectives: This study was performed to investigate the efficacy of nonoperative treatment of uncomplicated sigmoid volvulus (SV) using a transanal decompression tube (TDT). Methods: This was a single-center retrospective study in patients with SV treated between 2008 and 2021. For uncomplicated patients, nonoperative decompression of any of four types was performed: decompression with a colonoscope (CS), TDT without CS, TDT with CS (tip in the sigmoid colon), and TDT with CS (tip in the descending colon). Results: A total of 72 patients with 109 admissions were enrolled in the study. Of these, 69 patients with uncomplicated SV were initially managed nonoperatively, whereas no procedures were performed in three patients due to presentation with septic shock on arrival. Of the 69 patients, 11 underwent surgery and two refused surgical management. Three patients showed improved CS without TDT. Among 53 patients who improved nonoperatively with TDT, 14 (26.4%) experienced recurrence with a median (range) time to recurrence of 603 (43-2714) days. No early recurrence was observed. Of a total of 106 cases with decompression, 97 (91.5%) were performed with TDT and all were completed without complications. The median (range) duration of decompression using TDT in these 81 cases without surgery was 5 (2-11) days. In the Cox proportional hazards regression model, only previous history of SV was associated with recurrence (hazard ratio 3.60; 95% confidence interval 1.24-10.46, p = 0.02). Conclusions: Decompression using TDT is safe, effective, and may reduce the rate of recurrence in patients with uncomplicated SV.