Self-expanding metallic stents for palliation and as a bridge to minimally invasive surgery in colorectal obstruction.
OBJECTIVE
Acute colorectal obstruction is a potentially life-threatening emergency that requires immediate surgical treatment. Emergency procedures had an associated mortality rate of 10% to 30%. This encouraged development of other options, most notably self-expanding metallic stents. The primary endpoint of this study to is to report our group's experience.


METHODS
We performed a retrospective review of 37 patients who underwent self-expanding metallic stent placement for colorectal obstruction between July 2000 and May 2012. Data collected were age, comorbidities, diagnosis, intent of intervention (palliative vs bridge to surgery), complications, and follow-up.


RESULTS
The study comprised 21 men (56.76%) and 16 women (43.24%), with a mean age of 67 years. The intent of the procedure was definitive treatment in 22 patients (59.46%) and bridge to surgery in 15 (40.54%). The highest technical success rate was at the rectosigmoid junction (100%). The causes of technical failure were inability of the guidewire to traverse the stricture and bowel perforation related to stenting. The mean follow-up period was 9.67 months. Pain and constipation were the most common postprocedure complications.


CONCLUSIONS
The use of a self-expanding metallic stent has been shown to be effective for palliation of malignant obstruction. It is associated with a lower incidence of intensive care unit admission, shorter hospital stay, lower stoma rate, and earlier chemotherapy administration. Laparoscopic or robotic surgery can then be performed in an elective setting on a prepared bowel. Therefore the patient benefits from advantages of the combination of 2 minimally invasive procedures in a nonemergent situation. Further large-scale prospective studies are necessary.
Jackson South Community Hospital, Miami, FL, USA. hlujan15@me.com
Henry J
HJ
Lujan
Guilherme
G
Barbosa
Marianna S
MS
Zeichen
Wilmer N
WN
Mata
Victor
V
Maciel
Gustavo
G
Plasencia
Rene F
RF
Hartmann
Manuel
M
Viamonte
Roberto
R
Fogel
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010166:Palliative Care; D011474:Prosthesis Design; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents