Skip to main content
SpringerLink
Log in

The role of stents in the management of colorectal complications: a systematic review

  • Review
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Complications in colorectal surgery include a wide range of clinical conditions, which increase mortality, morbidity, hospital stay and costs. In some cases, the placement of a self-expanding metal stent may represent a possible therapeutic strategy, avoiding further surgery.

Methods

In order to verify the feasibility and safety of the technique, we reviewed the medical literature, between January 1997 and 2015, selecting 32 studies. Inclusion criteria were based on Preferred Reporting Items for Systematic reviews and Meta-Analyses recommendations.

Results

The estimated rate of early success was 73.3% (95% CI 66.3–79.3), raising from 25 to 68% in the time frame 1997–2007. The rate of early complications was 31.4% (95% CI 25.3–38.3%), progressively decreasing from 75 to 43% up to 2009. The rate of surgery for acute complication was 9.3% (95% CI 6.0–14.2%), reduced on time course from 25 to 9%. The rate of closure of dehiscence was 74.5% (95% CI 62.8–83.5%), while the rate of long-lasting success was 57.3% (95% CI 50.3–64.0%).

Conclusions

Endoscopic stenting in the early postoperative management of anastomotic complications after colorectal surgery should be considered in patients with minimal risk for sepsis, as a safe and often effective alternative to surgery. However, in order to establish the safety and efficacy of this technique, prospective studies involving a larger cohort of patients are required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Law WI, Chu KW, Ho JW et al (2000) Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg 179:92–96

    Article  CAS  PubMed  Google Scholar 

  2. Platell C, Barwood N, Dorfmann G et al (2007) The incidence of anastomotic leaks in patients undergoing colorectal surgery. Colorectal Dis 9:71–79

    Article  CAS  PubMed  Google Scholar 

  3. Schlegel RD, Dehni N, Parc R et al (2001) Results of reoperations in colorectal anastomotic strictures. Dis Colon Rectum 44:1464–1468

    Article  CAS  PubMed  Google Scholar 

  4. Schwarzer G (2007) Meta: an R package for meta-analysis. R News 7:40–45

    Google Scholar 

  5. Gürbulak EK, Akgün EE, Öz A et al (2015) Case report: minimal invasive management of anastomosis leakage after colon resection. Hindawi Publishing Corporation, Cairo

    Google Scholar 

  6. Caruso A, Conigliaro R, Manta R et al (2015) Fully covered self-expanding metal stents for refractory anastomotic colorectal strictures. Surg Endosc 29:1175–1178

    Article  PubMed  Google Scholar 

  7. Cooper CJ, Morales A, Othman MO (2014) Outcomes of the use of fully covered esophageal self-expandable stent in the management of colorectal anastomotic strictures and leaks. Hindawi Publishing Corporation, Cairo

    Google Scholar 

  8. Lamazza A, Fiori E, Sterpetti AV (2014) Endoscopic placement of self-expandable metal stents for treatment of rectovaginal fistulas after colorectal resection for cancer. Gastrointest Endosc 79:1025–1027

    Article  PubMed  Google Scholar 

  9. Lamazza A, Fiori E, Schillaci A, Sterpetti AV et al (2014) Treatment of anastomotic stenosis and leakage after colorectal resection for cancer with self-expandable metal stents. Am J Surg 208:465–469

    Article  PubMed  Google Scholar 

  10. Vanbiervliet G, Bichard P, Demarquay JF et al (2013) Fully covered self-expanding metal stents for benign colonic strictures. Endoscopy 45:35–41

    Article  CAS  PubMed  Google Scholar 

  11. Pérez Roldán F, González Carro P, Villafáñez García MC et al (2013) Endoscopic treatment of postsurgical colorectal anastomotic leak. Gastrointest Endosc 77:967–971

    Article  PubMed  Google Scholar 

  12. Lamazza A, Fiori E, De Masi E et al (2013) Self-expanding metal stents for treatment of anastomotic complications after colorectal resection. Endoscopy 45:493–495

    Article  CAS  PubMed  Google Scholar 

  13. Repici A, Pagano N, Rando G et al (2013) A retrospective analysis of early and late outcome of biodegradable stent placement in the management of refractory anastomotic colorectal strictures. Surg Endosc 27:2487–2491

    Article  CAS  PubMed  Google Scholar 

  14. Caruso A, Manno M, Manta R et al (2013) Alternative management of anastomotic colorectal strictures: our experience with fully covered self-expanding metal stents. Surg Endosc 27:4752–4753

    Article  PubMed  Google Scholar 

  15. DiMaio CJ, Dorfman MP, Gardner GJ et al (2012) Covered esophageal self-expandable metal stents in the nonoperative management of postoperative colorectal anastomotic leaks. Gastrointest Endosc 76:431–435

    Article  PubMed  Google Scholar 

  16. Janík V, Horák L, Hnaníček J et al (2011) Biodegradable polydioxanone stents: a new option for therapy-resistant anastomotic strictures of the colon. Eur Radiol 21:1956–1961

    Article  PubMed  Google Scholar 

  17. Kim SW, Lee WH, Kim JS et al (2013) Successful management of colonic perforation with a covered metal stent. Korean J Intern Med 28:715–717

    Article  PubMed  PubMed Central  Google Scholar 

  18. Saida Y, Enomoto T, Takabayashi K et al (2011) Outcome of 141 cases of self-expandable metallic stent placements for malignant and benign colorectal strictures in a single center. Surg Endosc 25:1748–1752

    Article  PubMed  Google Scholar 

  19. Pérez Roldán F, González Carro P, Villafáñez García MC et al (2012) Usefulness of biodegradable polydioxanone stents in the treatment of postsurgical colorectal strictures and fistulas. Endoscopy 44:297–300

    Article  PubMed  Google Scholar 

  20. Dai Y, Chopra SS, Wysocki WM et al (2010) Treatment of benign colorectal strictures by temporary stenting with self-expanding stents. Int J Colorectal Dis 25:1475–1479

    Article  PubMed  Google Scholar 

  21. Keränen I, Lepistö A, Udd M et al (2010) Outcome of patients after endoluminal stent placement for benign colorectal obstruction. Scand J Gastroenterol 45:725–731

    Article  PubMed  Google Scholar 

  22. Abbas MA (2009) Endoscopic management of acute colorectal anastomotic complications with temporary stent. JSLS 13:420–424

    PubMed  PubMed Central  Google Scholar 

  23. Amrani L, Ménard C, Berdah S et al (2009) From iatrogenic digestive perforation to complete anastomotic disunion: endoscopic stenting as a new concept of “stent-guided regeneration and re-epithelialization”. Gastrointest Endosc 69:1282–1287

    Article  PubMed  Google Scholar 

  24. Chopra SS, Mrak K, Hünerbein M (2009) The effect of endoscopic treatment on healing of anastomotic leaks after anterior resection of rectal cancer. Surgery 145:182–188

    Article  PubMed  Google Scholar 

  25. Rayhanabad J, Abbas MA (2009) Long-term outcome of endoscopic colorectal stenting for malignant and benign disease. Am Surg 75:897–900

    PubMed  Google Scholar 

  26. Small AJ, Young-Fadok TM, Baron TH (2008) Expandable metal stent placement for benign colorectal obstruction: outcomes for 23 cases. Surg Endosc 22:454–462

    Article  CAS  PubMed  Google Scholar 

  27. Abbas MA, Falls GN (2008) Endoscopic stenting of colovaginal fistula: the transanal and transvaginal “kissing” wire technique. JSLS 12:88–92

    PubMed  PubMed Central  Google Scholar 

  28. Forshaw MJ, Maphosa G, Sankararajah D et al (2006) Endoscopic alternatives in managing anastomotic strictures of the colon and rectum. Tech Coloproctol 10:21–27

    Article  CAS  PubMed  Google Scholar 

  29. Stefanidis D, Brown K, Nazario H et al (2005) Safety and efficacy of metallic stents in the management of colorectal obstruction. JSLS 9:454–459

    PubMed  PubMed Central  Google Scholar 

  30. Scileppi T, Li JJ, Iswara K et al (2005) The use of a Polyflex coated esophageal stent to assist in the closure of a colonic anastomotic leak. Gastrointest Endosc 62:643–645

    Article  PubMed  Google Scholar 

  31. Forshaw MJ, Sankararajah D, Stewart M et al (2006) Self-expanding metallic stents in the treatment of benign colorectal disease: indications and outcomes. Colorectal Dis 8:102–111

    Article  CAS  PubMed  Google Scholar 

  32. Guan YS, Sun L, Li X et al (2004) Successful management of a benign anastomotic colonic stricture with self-expanding metallic stents: a case report. World J Gastroenterol 10:3534–3536

    Article  PubMed  PubMed Central  Google Scholar 

  33. Delaunay-Tardy K, Barthélémy C, Dumas O et al (2003) Endoscopic therapy of benign colonic post-operative strictures: report on 27 cases. Gastroenterol Clin Biol 27:610–613

    PubMed  Google Scholar 

  34. Paúl L, Pinto I, Gómez H et al (2002) Metallic stents in the treatment of benign diseases of the colon: preliminary experience in 10 cases. Radiology 223:715–722

    Article  PubMed  Google Scholar 

  35. Odurny A (2001) Colonic anastomotic stenoses and Memotherm stent fracture: a report of three cases. Cardiovasc Interv Radiol 24:336–339

    Article  CAS  Google Scholar 

  36. Repici A, Reggio D, Saracco G et al (2000) Self-expanding covered esophageal Ultraflex stent for palliation of malignant colorectal anastomotic obstruction complicated by multiple fistulas. Gastrointest Endosc 51:346–348

    Article  CAS  PubMed  Google Scholar 

  37. Jeyarajah AR, Shepherd JH, Fairclough PD et al (1997) Effective palliation of a colovaginal fistula using a self-expanding metal stent. Gastrointest Endosc 46:367–369

    Article  CAS  PubMed  Google Scholar 

  38. Khan AA, Wheeler JM, Cunningham C et al (2007) The management and outcome of anastomotic leaks in colorectal surgery. Colorectal Dis 10:587–592

    Article  PubMed  Google Scholar 

  39. Mala T, Nesbakken A (2008) Morbidity related to the use of a protective stoma in anterior resection for rectal cancer. Colorectal Dis 10:785–788

    Article  CAS  PubMed  Google Scholar 

  40. Hunerbein M, Krause M, Moesta KT et al (2005) Palliation of malignant rectal obstruction with self-expanding metal stents. Surgery 137:42–47

    Article  PubMed  Google Scholar 

  41. Trovato C, Fiori G, Ravizza D et al (2006) Delayed colonic perforation after metal stent placement for malignant colorectal obstruction. Endoscopy 38(S2):E96

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy

    Alberto Arezzo, Giacomo Lo Secco & Mauro Verra

  2. Department of Surgical Sciences, San Giovanni Bosco Hospital, Turin, Italy

    Roberto Bini

  3. Division of Nuclear Medicine, University of Torino, Turin, Italy

    Roberto Passera

Authors
  1. Alberto Arezzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roberto Bini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giacomo Lo Secco
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mauro Verra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberto Passera
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alberto Arezzo.

Ethics declarations

Disclosures

Prof. Alberto Arezzo, Dr. Roberto Bini, Dr. Giacomo Lo Secco, Dr. Mauro Verra and Dr. Roberto Passera have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arezzo, A., Bini, R., Lo Secco, G. et al. The role of stents in the management of colorectal complications: a systematic review. Surg Endosc 31, 2720–2730 (2017). https://doi.org/10.1007/s00464-016-5315-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-016-5315-x

Keywords

Search

Navigation