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World J Gastrointest Surg. Jan 27, 2013; 5(1): 1-4
Published online Jan 27, 2013. doi: 10.4240/wjgs.v5.i1.1
Primary colon resection or Hartmann's procedure in malignant left-sided large bowel obstruction? The use of stents as a bridge to surgery
Reinhart T Grundmann
Reinhart T Grundmann, Formerly Kreiskliniken Altötting, D-84489 Burghausen, Germany
Author contributions: Grundmann RT solely contributed to this paper.
Correspondence to: Reinhart T Grundmann, Professor, Formerly Kreiskliniken Altötting, In den Grüben 144, D-84489 Burghausen, Germany.
Telephone: +49-8677-878483 Fax: +49-8677-6689140
Received: July 9, 2012
Revised: December 2, 2012
Accepted: December 20, 2012
Published online: January 27, 2013

There is still significant debate regarding the best surgical treatment for malignant left-sided large bowel obstruction. Primary resection and anastomosis offers the advantages of a definite procedure without need for further surgery. Its main disadvantages are related to the increased technical challenge and to the potential higher risk of anastomotic leakage that occurs in the emergency setting. Primary resection with end colostomy (Hartmann’s procedure) is considered the safer option. Tan et al compared in a systematic review and meta-analysis the use of self-expanding metallic stents (SEMS) as a bridge to surgery vs emergency surgery in the management of acute malignant left-sided large bowel obstruction. The authors concluded that the technical and clinical success rates for stenting were lower than expected. SEMS was associated with a high incidence of clinical and silent perforation. Stenting instead of loop colostomy can be recommended only if the appropriate expertise is available in the hospital. The goal of stenting, a decrease of the stoma rate, may be advocated only if the complication rates of stenting are lower than those of stoma creation in the emergency situation. Until now, this was not demonstrated in a prospective randomized trial.

Keywords: Left-sided large bowel obstruction, Hartmann’s procedure, Primary anastomosis, Bowel stent, Emergency treatment