title: Management of malignant left-sided large bowel obstruction: a comparison between colonic stents and surgery.
abstract: BACKGROUND
  Management of distal malignant large bowel obstruction (LBO) remains challenging. Acute surgical intervention is often associated with poorer clinical outcome compared to an elective procedure. Self-expandable metallic stents (SEMS) as a bridge to surgery (BTS) or palliation remain controversial and are not yet widely available.
  
  
  METHODS
  From 1998 to 2008, a retrospective analysis of the patients presenting with an acute malignant LBO to The Tweed Public and John Flynn Private Hospitals was performed.
  
  
  RESULTS
  Fifty-six admissions with malignant distal colonic obstruction were reviewed. On an intention to treat, patients underwent either stent 30 or surgery 26. American Association of Anaesthetists (ASA) scores, obesity rates and palliative procedures were all higher in the stent group. Inpatient deaths numbered four (two stent group, two surgery group). The technical success of inserted stents was 29/30, while clinical success was 27/30. Complications both medical, surgical and intensive care unit admissions were more common in the surgical group. Length of stay was 8.5 days for stent and 17.7 days for surgery. Of the 25 successful stent survivors, 14 were palliative and 11 were BTS.
  
  
  CONCLUSIONS
  SEMS are effective in treatment of LBO either as palliation or BTS. They are associated with an overall better outcome and improved quality of life of patients. Surgery is indicated where SEMS are unavailable or have failed.
authors.affiliation: Departments of General Surgery, The Tweed Hospital, Tweed Heads and Department of General Surgery and Gastroenterology, John Flynn Private Hospital, Tugun, Queensland, Australia. staff@swhite.com.au
authors.forename: Stephen I
authors.initials: SI
authors.lastname: White
authors.forename: S Ibrahim
authors.initials: SI
authors.lastname: Abdool
authors.forename: Brett
authors.initials: B
authors.lastname: Frenkiel
authors.forename: William V
authors.initials: WV
authors.lastname: Braun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000150:complications* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000523:psychology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome