Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Surg. Dec 27, 2012; 4(12): 289-295
Published online Dec 27, 2012. doi: 10.4240/wjgs.v4.i12.289
Managing acute colorectal obstruction by "bridge stenting" to laparoscopic surgery: Our experience
Pierfrancesco Bonfante, Luigi D’Ambra, Stefano Berti, Emilio Falco, Massimo Vittorio Cristoni, Romolo Briglia
Pierfrancesco Bonfante, Luigi D’Ambra, Stefano Berti, Emilio Falco, Department of Surgery, S.Andrea Hospital of La Spezia, 19100 La Spezia, Italy
Massimo Vittorio Cristoni, Romolo Briglia, Gastroenterological Unit, S.Andrea Hospital of La Spezia, 19100 La Spezia, Italy
Author contributions: All authors contributed equally to this work.
Correspondence to: Dr. Luigi D’Ambra, Department of Surgery, S.Andrea Hospital La Spezia, Via veneto 197, 19100 La Spezia, Italy.
Telephone: +39-187-533465 Fax: +39-187-5333752
Received: February 3, 2012
Revised: October 1, 2012
Accepted: December 1, 2012
Published online: December 27, 2012

AIM: To verify the clinical results of the endoscopic stenting procedure for colorectal obstructions followed by laparoscopic colorectal resection with “one stage anastomosis”.

METHODS: From March 2003 to March 2009 in our surgical department, 48 patients underwent endoscopic stenting for colorectal occlusive lesion: 30 males (62.5%) and 18 females (37.5%) with an age range from 40 years to 92 years (median age 69.5). All patients enrolled in our study were diagnosed with an intestinal obstruction originating from the colorectal tract without bowel perforation signs. Obstruction was primitive colorectal cancer in 45 cases (93.7%) and benign anastomotic stricture in 3 cases (6.3%).

RESULTS: Surgical resection was totally laparoscopic in 69% of cases (24 patients) while 17% (6 patients) of cases were video-assisted due to the local extension of cancer with infiltrations of surrounding structures (urinary bladder in 2 cases, ileus and iliac vessels in the others). In 14% of cases (5 patients), resection was performed by open surgery due to the high American Society of Anesthesiologists score and the elderly age of patients (median age of 89 years). We performed a terminal stomy in only 7 patients out of 35, 6 colostomies and one ileostomy (in a total colectomy). In the other 28 cases (80%), we performed bowel anastomosis at the same time as resection, employing a temporary ileostomy only in 5 cases.

CONCLUSION: Colorectal stenting transforms an emergency operation in to an elective operation performable in a totally laparoscopic manner, limiting the confection of colostomy with its correlated complications.

Keywords: Colorectal cancer, Laparoscopy, Colonic stenting, Intestinal obstruction, Endoscopy