Laparoscopic management for acute malignant colonic obstruction.
OBJECTIVE
We aimed to evaluate the feasibility of staged laparoscopic colectomy for acute malignant colon obstruction.


METHODS
Through a laparoscopic approach, emergency blowhole colostomy and subsequent elective resection were performed.


RESULTS
There were 14 men and 8 women, ages ranging from 42 to 79 years. All patients underwent laparoscopic blowhole colostomy for fecal diversion. Of these stomas, 6 were located at the splenic flexure, 7 at the descending colon, and 9 at the sigmoid colon. Subsequently, 20 of the 22 patients achieved an elective laparoscopic resection including takedown of the stoma. They were left hemicolectomy in 11 and anterior resection in 9. The mean total length of hospital stay was 20 ± 4.6 days (range, 16 to 33 d) in these 20 patients. The remaining 2 patients did not undergo reversal of the colostomy. The median follow-up period was 23 months. Seven patients died of disease progression and 15 patients remained alive and well.


CONCLUSIONS
Our results suggest that staged laparoscopic colon resection is a feasible and effective technique for acute malignant colonic obstruction. The length of hospital stay is justified as compared with conventional single-staged resection. Our technique can also be recommended when colonic stenting is not available.
Department of Surgery, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Fan-Ming
FM
Chen
Tzu-Chieh
TC
Yin
Wen-Chieh
WC
Fan
Che-Jen
CJ
Huang
Jan-Sing
JS
Hsieh
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003082:Colectomy / Q000379:methods; D003110:Colonic Neoplasms / Q000150:complications / Q000601:surgery*; D003125:Colostomy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil