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



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.



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%).



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.
Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy. alberto.arezzo@unito.it.
Alberto
0000-0002-2110-4082
A
Arezzo
Department of Surgical Sciences, San Giovanni Bosco Hospital, Turin, Italy.
Roberto
R
Bini
Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy.
Giacomo
G
Lo Secco
Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy.
Mauro
M
Verra
Division of Nuclear Medicine, University of Torino, Turin, Italy.
Roberto
R
Passera
D057868:Anastomotic Leak / Q000628:therapy*; D003106:Colon / Q000601:surgery*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy*; D011183:Postoperative Complications / Q000628:therapy; D012007:Rectum / Q000601:surgery*; D000069322:Self Expandable Metallic Stents; D016896:Treatment Outcome
Anastomotic fistula; Anastomotic leakage; Anastomotic stenosis; SEMS; Self-expandable stents