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Surgery Today
Published in: Surgery Today 9/2019

01-09-2019 | Enterostomy | Review Article

Short-term outcomes of a self-expandable metallic stent as a bridge to surgery vs. a transanal decompression tube for malignant large-bowel obstruction: a meta-analysis

Authors: Akihisa Matsuda, Takeshi Yamada, Satoshi Matsumoto, Nobuyuki Sakurazawa, Youichi Kawano, Kumiko Sekiguchi, Takeshi Matsutani, Masao Miyashita, Hiroshi Yoshida

Published in: Surgery Today | Issue 9/2019

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Abstract

Purpose

Preoperative intestinal decompression, using either a self-expandable metallic stent (SEMS) as a bridge to surgery (BTS) or a transanal decompression tube (TDT), provides an alternative to emergency surgery for malignant large-bowel obstruction (MLBO). We conducted this meta-analysis to compare the short-term outcomes of SEMS placement as a BTS vs. TDT placement for MLBO.

Methods

We conducted a comprehensive electronic search of literature published up to March, 2018, to identify studies comparing the short-term outcomes of BTS vs. TDT. Decompression device-related and surgery-related variables were evaluated and a meta-analysis was performed using random-effects models to calculate odd ratios with 95% confidence intervals.

Results

We analyzed 14 nonrandomized studies with a collective total of 581 patients: 307 (52.8%) who underwent SEMS placement as a BTS and 274 (47.2%) who underwent TDT placement. The meta-analyses showed that the BTS strategy conferred significantly better technical and clinical success, helped to maintain quality of life by allowing free food intake and temporal discharge, promoted laparoscopic one-stage surgery without stoma creation, and had equivalent morbidity and mortality to TDT placement.

Conclusions

Although the long-term outcomes are as yet undetermined, the BTS strategy using SEMS placement could be a new standard of care for preoperative decompression to manage MLBO.
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Metadata
Title
Short-term outcomes of a self-expandable metallic stent as a bridge to surgery vs. a transanal decompression tube for malignant large-bowel obstruction: a meta-analysis
Authors
Akihisa Matsuda
Takeshi Yamada
Satoshi Matsumoto
Nobuyuki Sakurazawa
Youichi Kawano
Kumiko Sekiguchi
Takeshi Matsutani
Masao Miyashita
Hiroshi Yoshida
Publication date
01-09-2019
Publisher
Springer Singapore
Published in
Surgery Today / Issue 9/2019
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-019-01784-y

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