Balagué C, Eduardo M Targarona, Sainz S, Martínez C, Garriga J, González D, Trías M

Language: Spanish
References: 14
Page: 19-24
PDF size: 74.51 Kb.

ABSTRACT

Introduction: The most widely used treatment of malignant obstruction consists of resection of the colonic segment and terminal colostomy (Hartmann’s operation). Alternative techniques to avoid stoma are subtotal colectomy or segmental colectomy with intraoperative lavage. However, although there are many arguments in favor of surgery in a single intervention, this is possible less than 70% of patients. Another technical alternative to this intervention consists of the implantation of a self-expandable stent with palliative intent or as a previous step to elective conventional colectomy. This avoids the need for colostomy. In addition, the possibility of laparoscopic colectomy allows a minimally invasive approach to be used with all the advantages that this provides in terms of patient comfort.
Patients and method: From a prospective database of 520 patients with colorectal disease who underwent laparoscopic surgery in our department, we reviewed the results obtained in five patients who had previously undergone placement of a stent to resolve complete obstruction due to cancer of the left colon. Demographic data, tumoral characteristics, data concerning the placement of the stent and laparoscopic surgery as well as postoperative outcome were collected.
Results: The lesions were localized in the sigmoid-rectum (one patient), sigmoid colon (two patients) and descending colon (four patients). The stent resolved obstruction in the seven patients who tolerated oral feeding 24 hours after placement. One patient presented an episode of mild rectorrhagia that was self-limiting without the need for transfusion. The seven patients underwent surgery 8 days (range: 6-14) after stent placement. One patient required conversion to open surgery and another required hand-assisted laparoscopic surgery. The need for conversion was not caused by difficulties related to the stent.
Conclusions: The preliminary results of the combination of stent-elective surgery reinforce the advantages of this option, especially if two minimally invasive techniques (stent and laparoscopic colectomy) are performed consecutively. This avoids the need for stoma and provides the clinical advantages of the laparoscopic approach.

REFERENCES

1. Ahmad T, Mee AS. Expandable metal stents in malignant colorectal obstruction. BMJ 2000; 321: 584-5.

2. Deans GT, Krukowsky ZH, Irwing ST. Malignant obstruction of the left colon. Br J Surg 1994; 81: 1270-6.

3. SCOTIA study group. Single-stage treatment for malignant left-side colonic obstruction: a prospective randomized clinical trial comparing subtotal colectomy with segmental resection following intraoperative irrigation. Br J Surg 1995; 82: 1622-7.

4. Biondo S, Jaurrieta E, Jorba R, Moreno P, Farran L, Borobia F et al. Intraoperative colonic lavage and primary anastomosis in peritonitis and obstruction. Br J Surg 1997; 84: 222-5.

5. Vrazas JI, Ferris S, Bau S, Faragher I. Stenting for obstructing colorectal malignancy: an interim or definitive procedure. ANZ J Surg 2002; 72: 392-6.

6. Knook MM, Targarona EM, Garriga J, Cerdan G, Trias M. Applicability of laparoscopic surgery for colorectal disease. J Laparoendosc Adv Surg Tech A 2000; 10: 263-8.

7. Dohmoto M, Rupp KD, Hohlbach G. Endoscopically-implanted prosthesis in rectal carcinoma. Dtsch Med Wochenschr 1990; 115: 915.

8. Martínez-Santos C, Lobato RF, Fradejas JM, Pinto I, Ortega-Deballón P, Moreno-Azcoita M. Self-expandable stent before elective surgery vs emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum 2002; 45: 401-6.

9. Chung CC, Kwok SP, Kwong KH, Lau WY, Li AK. Technique of laparoscopically assisted on-table colonic irrigation. Br J Surg 1997; 84: 384.

10. Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 2002; 359: 2224-9.

11. Goyal A, Schein MC. Current practices in left-sided colonic emergencies: a survey of US gastrointestinal surgeons. Dig Surg 2001; 18: 399-402.

12. Khot UP, Lang A, Mutrali K, Parker MC. Systematic review of the efficacy and safety of colorectal stents. Br J Surg 2002; 89: 1096-102.

13. Targarona EM, Gracia E, Garriga J, Martínez BC, Cortés C, Boluda R et al. Prospective randomized trial comparing conventional laparoscopic colectomy with hand assisted laparoscopic colectomy. Applicability, immediate clinical outcome, inflammatory response and cost. Surg Endosc 2002; 16: 234-9.

14. Morino M, Bertello A, Garbarini A, Rozzio G, Repici A. Malignant colonic obstruction managed by endoscopic stent decompression followed by laparoscopic resections. Surg Endosc 2002; 16: 1483-7.