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Publications : Abstracts

> One-Stage Laparoscopic Colorectal Resection after Placement of Self-Expanding Metallic Stents for Colorectal Obstruction : A Prospective Study - Dulucq JL, Wintringer P, Beyssac R, Barberis C, Talbi P, Mahajna A.


Abstract

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 succesful 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 and surgery was 6.2 days. Mean operating time was 132 ± 38 minutes. No cases that 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.

Keywords.

Self-expanding metal stents - Large bowel obstruction - Colonic neoplasm - Colonoscopy - Laparoscopy

Large bowel obstruction is an abdominal emergency; caused mainly by malignancy. Approximately 20% of patients with colonic tumors suffer large bowel obstruction. The management of colonic obstruction is in general a surgical procedure that consits of excision of the obstructing lesion and diversion of the fecal stream. A second procedure is required to restore colonic continuity. Recently, some authors advocated the use of a single-stage resection and primary anastomosis with or without intraoperative colonic lavage. Others recommended subtotal colectomy as a safe operation. These urgent surgical procedures are associated with high mortality and morbidity rates.

The placement of self-expandable metallic stents (SEMS) for the relief of colonic obstruction was first described in 1991 by Dohmoto. Since then, the use of metallic stents expanded widely and includes 2 main indications : definitive palliative treatment for patients with obstructive disease in whom resection is not curative due to an unresectable tumor, matastatic diseaese, or hight operative risk. Second, as a bridge to 1 stage elective surgery, as it allows preliminary complete evaluation and mechanical bowel preparation.

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