One-Stage Laparoscopic Colorectal Resection after Placement of Self-Expanding Metallic Stents for Colorectal Obstruction
- 154 Downloads
The aim of this study was to assess the clinical outcomes of self-expandable metallic stents placing followed by laparoscopic resection and primary anastomosis for the treatment of acute colonic obstruction. From January 2003 to December 2004, 14 patients diagnosed with acute and complete colonic obstruction were treated with endoscopic colonic stenting as a bridge to an elective 1-stage laparoscopic resection. Three patients who underwent a successful stent insertion but had an inoperable tumor were excluded from the analyzed data. Ninety-three percent technical and clinical success was achieved. The stent insertion related perforation rate was 7% (1/14). The mean duration of stent insertion was approximately 1 hour and the mean time between the stent insertion and surgery was 6.2 days. Mean operating time was 132 ± 38 minutes. No cases required conversion to laparotomy and there were no intraoperative complications. One case of anastomotic leakage was observed and treated by laparoscopic drainage and protective ileostomy. Ambulation time after operation was 1.8 ± 0.6 days and total hospital stay length was 16.4 ± 5.0 days. During a period of 11 ± 7 months of follow-up, neither recurrences nor port-site metastases were observed. The management of acute colonic obstruction using endoscopic stent decompression, followed by laparoscopic resection, had good results and can be considered feasible and safe. Larger comparative studies may help to establish this approach.
KeywordsSelf-expanding metal stents Large bowel obstruction Colonic neoplasm Colonoscopy Laparoscopy
The authors thank Dr Mitkal Sharon for valuable help in proofreading this article.
- 3.Philips RK, Hittinger R, Fry JS, Fielding LP (1985) Malignant large bowel obstruction. Br J Surg 72:296–302Google Scholar
- 9.Dohmoto M (1991) New method-endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endoscopia Digestiva 3:1507–15012Google Scholar
- 16.Dulucq JL (2005) Tips and techniques in laparoscopic surgery (laparoscopic left colectomy, laparoscopic right colectomy). Springer-Verlag, Berlin, pp 118–148Google Scholar
- 19.Stoianov KH, Karashmalukov A, Luliianov A, Rachkov I, Vulchev D (1998) An analysis of postoperative mortality in patients with large intestine occlusive ileus due to tumor origin. Khirurgiia (Sofiia) 51:17–19Google Scholar
- 28.Martinez-Santos C, Lobato RS, Fradejas JM, Pinto I, Ortega-Deballon P, Moreno-Azcoita M (2002) Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum 45:401–406CrossRefPubMedGoogle Scholar