Right Colonic Surgery
AfterTajero et al, in 1994 expounded the role of SEMS as a BTS, a number of studies highlighted its significance in managing left-sided colonic obstruction. However, there is a constrained data about SEMS insertion for right colonic lesions. The reason is that right colonic obstruction causes retention of less amount of fecal material(17)and can be managed by 1-stage emergency surgery (resection and primary anastomosis) without any bowel preparation andcolostomy/ileostomy formation(18).Albeit SEMS insertion for right colonic obstruction could be a significant therapeutic option, but conflicting results subsist, hence surgical resection is the initial pick. SEMS insertion, if considered owing to other co-morbidities, then meticulously culling
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Pre-operative SEMS insertion in such cases not only converts an emergent multi-stage surgery to a semi-elective single-stage surgery with amended results and lower colostomy/ileostomyrates(20). It additionally sanctions time to amend the patient’s functional status by resuscitation, optimizing the co-morbidities, bowel preparation, pre-operative assessment (tumor staging, synchronous lesion screening) and to implement neo-adjuvant chemotherapy, if required(21-23). Studies have reported that pre-operative SEMS insertion as BTS can augment primary anastomosis rate and taper the post-operative morbidity rate, colostomy/ileostomy rate, admission to the intensive care unit (ICU) and other post-operative complications(24, 25). Despite these short-term propitious outcomes, the overall post-operative mortality rate is kindred in both SEMS as BTS and emergency surgery settings(23). Moreover, the long-term oncologicaldenouement/disease atavism as a result of dispersal of cancer cells during SEMS insertion(26), is worse in SEMS as BTS than in emergency surgery(27, 28). Predicated on these findings, the European Society of Gastrointestinal Endoscopy (ESGE)SEMS guidelines recommend emergency surgery should be considered as the 1st line of treatment in potentially curable lesions unless the patient carries a high risk of post-operative mortality (patient’s age >70 years and those with an American Society of Anesthesiologists (ASA) class >
Pre-operative SEMS insertion in such cases not only converts an emergent multi-stage surgery to a semi-elective single-stage surgery with amended results and lower colostomy/ileostomyrates(20). It additionally sanctions time to amend the patient’s functional status by resuscitation, optimizing the co-morbidities, bowel preparation, pre-operative assessment (tumor staging, synchronous lesion screening) and to implement neo-adjuvant chemotherapy, if required(21-23). Studies have reported that pre-operative SEMS insertion as BTS can augment primary anastomosis rate and taper the post-operative morbidity rate, colostomy/ileostomy rate, admission to the intensive care unit (ICU) and other post-operative complications(24, 25). Despite these short-term propitious outcomes, the overall post-operative mortality rate is kindred in both SEMS as BTS and emergency surgery settings(23). Moreover, the long-term oncologicaldenouement/disease atavism as a result of dispersal of cancer cells during SEMS insertion(26), is worse in SEMS as BTS than in emergency surgery(27, 28). Predicated on these findings, the European Society of Gastrointestinal Endoscopy (ESGE)SEMS guidelines recommend emergency surgery should be considered as the 1st line of treatment in potentially curable lesions unless the patient carries a high risk of post-operative mortality (patient’s age >70 years and those with an American Society of Anesthesiologists (ASA) class >