ORIGINAL ARTICLES   

Minerva Chirurgica 2013 June;68(3):299-306

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: Italian

Self expandable metal stent as bridge-to-surgery in acute bowel obstruction

Giannessi S. ¹, Paroli G. M. ¹, Fedi M. ¹, Riccadonna S. ¹, Gori A. ¹, Lombardi M. ², Colugnat D. ², Da Massa Carrara P. ², De Carli V. ² ✉

¹ Unità Operativa di Chirurgia Generale Azienda USL 3, Ospedale “del Ceppo Pistoia, Italia; ² Area Funzionale Medica Sezione di Endoscopia Digestiva Ospedale “del Ceppo”, Pistoia, Italia

Aim: Self expandable metal stent (SEMS) can be used to relieve malignant colorectal obstruction. The stent serves as a palliative measure for high-risk patients or those with unresecable tumor on subsequent workup. For low-risk patients with resecable disease, SEMS serves as a safe and effective bridge to subsequent laparoscopic surgery.
Methods: From August 2009 to April 2012 we have treated with SEMS 39 patients, 20 of whom with palliative purpose; 19 patients are treated with SEMS for bridge to surgery, out of these patients, 8 were women, 11 men with median age of 61.4 years (range 36-81 years). Technical success, defined as a successful stent placement and deployment in the stricture site, was achieved for 39/40 patients (97.5%). The average duration of the procedure was about 60 minutes (range 15-120).
Results: Clinical success was achieved for all the 39 patients, 19 of these could be subjected to bowel preparation and colon resection after 25 days from the positioning. No colostomy was performed. Among patients undergoing the procedure, perforation occurred in 1 case.
Conclusion: In summary, the colonic stent placement is a complex method that needs qualified medical-nursing team, able to solve any difficult situation, such as the severe, irregular and distal obstruction. SEMS positioning guarantees a high percentage of clinical and technical success; however it is necessary to pay attention to the risk of complications like bowel perforation.