Effectiveness and early postoperative outcomes of palliative endoluminal stenting versus Hartmann’s procedure in acute malignant bowel obstruction in high-risk patients
Purpose The emergency intervention for acute malignant left-sided colonic obstruction remains controversial. Conflicting reports exist regarding the efficacy and safety of endoscopic placement of self-expandable metallic stents (SEMS) vs. primary surgery. Most reports focus on SEMS insertion as a br...
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| Format: | Article |
| Language: | English |
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Korean Society of Coloproctology
2022-04-01
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| Series: | Annals of Coloproctology |
| Subjects: | |
| Online Access: | http://coloproctol.org/upload/pdf/ac-2021-01-28.pdf |
| _version_ | 1828383433776168960 |
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| author | Mohammed Fayek Mahfouz Tamer M. Saeid Salama Amr H. Afifi Hany Mansour Khalil Dabous |
| author_facet | Mohammed Fayek Mahfouz Tamer M. Saeid Salama Amr H. Afifi Hany Mansour Khalil Dabous |
| author_sort | Mohammed Fayek Mahfouz |
| collection | DOAJ |
| description | Purpose The emergency intervention for acute malignant left-sided colonic obstruction remains controversial. Conflicting reports exist regarding the efficacy and safety of endoscopic placement of self-expandable metallic stents (SEMS) vs. primary surgery. Most reports focus on SEMS insertion as a bridge to surgery. Methods An observational nonrandomized study at a single center in Cairo, Egypt included 65 high-risk patients (American Society of Anesthesiologists physical status classification ≥ III, age > 60 years) with acute malignant metastatic (stage IV) colonic obstruction. Twenty-nine patients underwent primary surgery (Hartmann’s procedure, HP), and 35 patients underwent SEMS insertion. Results All cases that underwent SEMS insertion were technically successful. The 2 procedures were comparable in clinical success rates but a statistically significant difference existed between them regarding the duration of postoperative hospital stay in the HP and SEMS group (7.7 ± 3.1 days vs. 3.5 ± 0.6 days, retrospectively; P < 0.001), the interval before regaining oral feeding (41.8 ± 26.8 hours vs. 27.6 ± 18.5 hours, retrospectively; P = 0.015), and the duration of intensive care unit (ICU) admission (5.0 ± 1.7 days vs. 1.5 ± 0.7 days, retrospectively; P = 0.035). Six patients (20.7%) in the HP group and 2 patients (5.7%) in the SEMS group required postoperative ICU admission. Conclusion SEMS placement provides comparable efficacy and safety to HP in managing acute malignant obstruction of the rectosigmoid region in high-risk individuals, with faster recovery and less hospital and ICU admission time. |
| first_indexed | 2024-12-10T04:47:59Z |
| format | Article |
| id | doaj.art-8e6566f6c33c483bb62fdcbbe9e250ea |
| institution | Directory Open Access Journal |
| issn | 2287-9714 2287-9722 |
| language | English |
| last_indexed | 2024-12-10T04:47:59Z |
| publishDate | 2022-04-01 |
| publisher | Korean Society of Coloproctology |
| record_format | Article |
| series | Annals of Coloproctology |
| spelling | doaj.art-8e6566f6c33c483bb62fdcbbe9e250ea2022-12-22T02:01:41ZengKorean Society of ColoproctologyAnnals of Coloproctology2287-97142287-97222022-04-0138214114510.3393/ac.2021.01.281823Effectiveness and early postoperative outcomes of palliative endoluminal stenting versus Hartmann’s procedure in acute malignant bowel obstruction in high-risk patientsMohammed Fayek Mahfouz0Tamer M. Saeid Salama1Amr H. Afifi2Hany Mansour Khalil Dabous3 Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt Department of Hepatology and Gastroenterology, Faculty of Medicine, Ain Shams University, Cairo, EgyptPurpose The emergency intervention for acute malignant left-sided colonic obstruction remains controversial. Conflicting reports exist regarding the efficacy and safety of endoscopic placement of self-expandable metallic stents (SEMS) vs. primary surgery. Most reports focus on SEMS insertion as a bridge to surgery. Methods An observational nonrandomized study at a single center in Cairo, Egypt included 65 high-risk patients (American Society of Anesthesiologists physical status classification ≥ III, age > 60 years) with acute malignant metastatic (stage IV) colonic obstruction. Twenty-nine patients underwent primary surgery (Hartmann’s procedure, HP), and 35 patients underwent SEMS insertion. Results All cases that underwent SEMS insertion were technically successful. The 2 procedures were comparable in clinical success rates but a statistically significant difference existed between them regarding the duration of postoperative hospital stay in the HP and SEMS group (7.7 ± 3.1 days vs. 3.5 ± 0.6 days, retrospectively; P < 0.001), the interval before regaining oral feeding (41.8 ± 26.8 hours vs. 27.6 ± 18.5 hours, retrospectively; P = 0.015), and the duration of intensive care unit (ICU) admission (5.0 ± 1.7 days vs. 1.5 ± 0.7 days, retrospectively; P = 0.035). Six patients (20.7%) in the HP group and 2 patients (5.7%) in the SEMS group required postoperative ICU admission. Conclusion SEMS placement provides comparable efficacy and safety to HP in managing acute malignant obstruction of the rectosigmoid region in high-risk individuals, with faster recovery and less hospital and ICU admission time.http://coloproctol.org/upload/pdf/ac-2021-01-28.pdfendoscopic stentinghartmann’s procedurecolonic obstructioncolorectal neoplasms |
| spellingShingle | Mohammed Fayek Mahfouz Tamer M. Saeid Salama Amr H. Afifi Hany Mansour Khalil Dabous Effectiveness and early postoperative outcomes of palliative endoluminal stenting versus Hartmann’s procedure in acute malignant bowel obstruction in high-risk patients Annals of Coloproctology endoscopic stenting hartmann’s procedure colonic obstruction colorectal neoplasms |
| title | Effectiveness and early postoperative outcomes of palliative endoluminal stenting versus Hartmann’s procedure in acute malignant bowel obstruction in high-risk patients |
| title_full | Effectiveness and early postoperative outcomes of palliative endoluminal stenting versus Hartmann’s procedure in acute malignant bowel obstruction in high-risk patients |
| title_fullStr | Effectiveness and early postoperative outcomes of palliative endoluminal stenting versus Hartmann’s procedure in acute malignant bowel obstruction in high-risk patients |
| title_full_unstemmed | Effectiveness and early postoperative outcomes of palliative endoluminal stenting versus Hartmann’s procedure in acute malignant bowel obstruction in high-risk patients |
| title_short | Effectiveness and early postoperative outcomes of palliative endoluminal stenting versus Hartmann’s procedure in acute malignant bowel obstruction in high-risk patients |
| title_sort | effectiveness and early postoperative outcomes of palliative endoluminal stenting versus hartmann s procedure in acute malignant bowel obstruction in high risk patients |
| topic | endoscopic stenting hartmann’s procedure colonic obstruction colorectal neoplasms |
| url | http://coloproctol.org/upload/pdf/ac-2021-01-28.pdf |
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