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Protocol‐driven self‐expanding metallic stenting for malignant large‐bowel obstruction in a district hospital
Author(s) -
Lo Xina,
Li KaHo,
Fok Benny KaLung,
Poon Michael ChiMing,
Cheung Michael HoYin,
Li Raymond ShiuKi,
Leong HengTat
Publication year - 2014
Publication title -
surgical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.109
H-Index - 10
eISSN - 1744-1633
pISSN - 1744-1625
DOI - 10.1111/1744-1633.12077
Subject(s) - medicine , stoma (medicine) , large bowel obstruction , surgery , case selection , bowel obstruction , stent , general surgery
Aim The acute management of non‐perforated malignant large‐bowel obstruction ( MLBO ) now includes self‐expanding metallic stenting ( SEMS ) as one of the possible options. Whether it can be the standard treatment of MLBO, however, remained controversial. Patients and Methods Our hospital adopted a new protocol concerning case selection, timing and personnel involved in SEMS since J anuary 2009 to incorporate this option into our management flow of MLBO ; data were prospectively collected. Outcome measures included technical and clinical success, related complications, subsequent operation type, stoma formation, patency and survival of patients. Results A total of 48 patients attempted SEMS to relieve their obstruction, 50 per cent with an aim as bridge to definitive surgery and 50 per cent for palliation of incurable disease on presentation, during the initial period from J anuary 2009 to J une 2011. The technical and clinical success rates were 91.6 per cent and 89.6 per cent, respectively, without immediate perforations. The overall stoma rate was 22.9 per cent. Conclusion With standardization by way of a well‐designed protocol, SEMS can be recommended as part of a routine‐management option of MLBO in centres with expertise available to produce favourable results.