title: Use of covered self-expandable stents for benign colorectal disorders in children.
abstract: OBJECTIVE
  There is a lack of experience with covered self-expandable stents for benign colorectal disorders in children.
  
  
  METHODS
  Five children (4M, 1F) with a median age of 5years (range, 6months-9years) who underwent treatment with covered self-expandable plastic (SEPSs) or self-expandable metal stents (SEMSs) for a benign colorectal condition between April 2005 and November 2013 were recruited to this retrospective study. Etiologies included: anastomotic stricture with (n=1) or without (n=3) simultaneous enterocutaneous fistula, as well as an anastomotic leak associated with enterocutaneous fistula (n=1). All children suffered from either Hirschsprung's disease (n=3) or total colonic aganglionosis (Zuelzer-Wilson syndrome) (n=2).
  
  
  RESULTS
  Median duration of individual stent placement was 23days (range, 1-87days). In all cases up to five different stents were placed over time. At follow-up two patients were successfully treated without further intervention. In another patient the anastomotic stricture resolved fully, but a coexisting enterocutaneous fistula persisted. Overall, three patients did not improve completely following stenting and required definite surgery. Stent-related problems were noted in all cases. There was one perforation of the colon at stent insertion. Further complications consisted of stent dislocation (n=4), obstruction (n=1), formation of granulation tissue (n=1), ulceration (n=1) and discomfort (n=3).
  
  
  CONCLUSIONS
  Covered self-expandable stents enrich the armamentarium of interventions for benign colorectal disorders in children including anastomotic strictures and intestinal leaks. A stent can be applied either as an emergency procedure (bridge to surgery) or as an adjuvant treatment further to endoscopy and dilatation. Postinterventional problems are frequent but there is a potential for temporary or definite improvement following stent insertion.
authors.affiliation: Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Department of Pediatric Surgery, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany. Electronic address: bettina.lange@umm.de.
authors.forename: Bettina
authors.initials: B
authors.lastname: Lange
authors.affiliation: Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Central Interdisciplinary Endoscopy, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Sold
authors.affiliation: Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Central Interdisciplinary Endoscopy, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Kähler
authors.affiliation: Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Department of Pediatric Surgery, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany.
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Wessel
authors.affiliation: Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Department of Pediatric Surgery, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Kubiak
mesh_terms: D002648:Child; D002675:Child, Preschool; D020099:Coated Materials, Biocompatible; D003106:Colon / Q000601:surgery*; D003108:Colonic Diseases / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011474:Prosthesis Design; D012002:Rectal Diseases / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible
keywords: Children; Covered self-expandable stents; Hirschsprung's disease; Intestinal stricture; Total colonic aganglionosis