DOI: 10.32322/jhsm.2019254 ISSN: 2636-8579

Self-expandable metallic stent as a bridge to surgery for malignant left-sided colorectal obstruction: initial experience from a single-centre case series

Ahmet Sencer Ergin, Onur Çakır, Alparslan Saylar, Ali Karabulut, Nihat Buğdaycı, Serhat Meriç, Hakan Yiğitbaş, Osman Bilgin Gülçiçek
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Aims: Self-expandable metal stenting (SEMS) may convert emergency surgery for malignant left-sided colorectal obstruction into elective resection. This study evaluated SEMS placement as a bridge to surgery (BTS).Methods: This retrospective single-centre case series included consecutive SEMS attempts for malignant obstruction of the descending colon, sigmoid colon or rectosigmoid. Technical success was the primary outcome. Clinical success and procedure-related adverse events were assessed, with operative, postoperative and pathological outcomes described after successful bridging.Results: Of 26 patients undergoing attempted or completed SEMS placement, five treated with palliative intent were excluded. Technical success and successful bridging were achieved in 16/21 BTS attempts (76.2%; 95% confidence interval, 52.8-91.8). All 16 achieved clinical decompression. The five technical failures underwent emergency Hartmann’s procedure. No perforation or clinically significant bleeding occurred in 21 attempts; no migration or re-obstruction occurred after 16 successful deployments. Among successfully bridged patients, the median interval to surgery was 5 days. Primary anastomosis was performed in 15 (93.8%), and seven (43.8%) received a stoma, including six diverting ileostomies. Five (31.3%) developed postoperative complications; four had a highest Clavien-Dindo grade of I and one had grade II. No anastomotic leakage, reoperation or 30-day mortality was recorded in this cohort. Median postoperative stay was 6.5 days (interquartile range, 5-9).Conclusion: Successful SEMS placement enabled decompression and elective resection. The 76.2% technical success rate, selected population and small retrospective cohort limit conclusions regarding overall safety and comparative effectiveness.

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