Short-term outcomes of stents in obstructive rectal cancer: A systematic review and meta-analysis.

BACKGROUND: With acute obstruction due to rectal or recto-sigmoid cancer, the safety and success of deploying self-expandable metal stents has been controversial. The aim of this systematic review was to synthesize the existing evidence on the outcomes and complication rates of stent placement in these patients. METHODS: We performed a literature search of PubMed by using appropriate keywords, and manual reference screening of included articles was done. The article screening, data extraction, and quality assessment was done by four independent reviewers. A meta analyses was performed for the main outcome measures: technical and clinical success and complication rates. RESULTS: We identified 962 articles in the search. After applying inclusion and exclusion criteria, we included 32 articles in the meta-analysis. The pooled technical success rate across 26 studies that reported it was 97% [95% confidence interval (CI): 95%-99%] without evidence of significant heterogeneity (I2 = 0.0%, P = 0.84), and the clinical success rate across 26 studies that reported it was 69% (95% CI: 58%-79%) with evidence of significant heterogeneity (I2 = 81.7%, P < 0.001). The pooled overall complication rate across the 32 studies was 28% (95% CI: 20%-37%) with evidence of significant heterogeneity (I2 = 79.3%, P < 0.001). CONCLUSION: The use of rectal stents in obstructing rectal or recto-sigmoid tumors seems to be technically feasible. A high rate of technical success, however, does not always translate into clinical success. A considerable complication rate is associated with this approach. Randomized controlled trials are needed to compare the outcomes of rectal stent placement with those of surgery.

Public perception of bariatric surgery.

OBJECTIVE: To investigate the public perception of morbid obesity and bariatric surgery in Saudi Arabia. Methods: A cross-sectional study was conducted between November 2016 and November 2017 in Jeddah, Saudi Arabia, including Saudis aged ≥18 years. Medical students, physicians, and individuals who underwent bariatric surgery were excluded. Participants were interviewed using a new, validated questionnaire.  Results: We interviewed 1,129 individuals of whom 744 (65.9%) were women. The educational level of most was a bachelor's degree. Most participants (97.7%) acknowledged the association between obesity and comorbidities. Approximately 22.7% of the participants were unaware of the bariatric surgery procedure. Approximately 18.9% considered it to be a cosmetic procedure. Approximately 50% were unaware of the correct indications for bariatric surgery, and 41.2% were unwilling to seek a bariatric surgeon's help if diagnosed with morbid obesity. These results were correlated with the participants' education level. Conclusion: Our study shows that the public perception of obesity and bariatric surgery in Saudi Arabia is limited. Effective interagency coordination between surgeons, health educators, and other health care providers is required to improve public awareness.