Objectives: To retrospectively evaluate surgical outcome of endoscopic colonic stenting (ECS) and elective surgery (ES) versus emergency surgery (ES) in acute left-sided malignant colonic obstruction.Patients & Methods: This retrospective study include 78 patients who were admitted with acute left-sided malignant colonic obstruction existing for <one week with obstructive symptoms defined as colonic dilation on plain abdominal X-ray or CT-abdomen with contrast compatible with a malignant colonic stricture. Files were categorizedaccording the type of management into ES (Group A) and ECS (Group B) included only patients had ECS; prepared and investigated and then were subjected to ES. Procedural and post-procedural data were collected.Results: The study included 78 patients; 37 had ES and 41 had ECS. Technical and clinical success rates of ECS were 100% and 85.4%, respectively. Twenty-nine patients (37.2%) had resection and primary anastomosis without colostomy with significantly higher frequency in favor of Group B. Twenty-one patients (26.9%) had resection and primary anastomosis with colostomy, respectively with significantly higher frequency in group A. Twenty one patients had Hartman's operation with significantly higher frequency in group A. Thirty-two patients had closure of colostomy after a mean duration of diversion of 4.8±0.8 months with non-significant difference between both groups. In five of patients had Hartman's operation the lesion was irresectable and colostomy was maintained as a definitive therapy. Twenty-five patients were admitted to ICU for their immediate postoperative (PO) care with significantly higher frequency and longer ICU stay duration in group A. Mean total hospital stay was significantly longer and frequency of patients had longer hospital stay were significantly higher in group A. Forty-five complications; 23 and 22 in groups A and B, respectively, were encountered with non-significantly higher frequencyin group A. One patient in group A developed local recurrence at the anastomotic site and required surgical interference and permanent colostomy. Four patients in group B developed stent obstruction and was removed; re-stenting was successful in 3 patients. Mortality rate was 11.5% with significantly higher frequency in group A.
Conclusion: ECS of patients with acute left-sided malignant colonic obstruction is effective procedure with technicaland clinical success rates of 100% and 85.4%, respectively. ECS relieve of obstruction allowed significantly higher rate of resection and primary anastomosis without colostomy, reduced the need for diverting colostomy with significant reduction of the need for ICU admission and ICU and total hospital stay without significant increase of PO morbidity and mortality. |
