Digestive Surgery
Original Paper
Minimally Invasive Treatment for Obstructive Tumors of the Left Colon: Endoluminal Self-Expanding Metal Stent and Laparoscopic ColectomyPreliminary Results aDepartment of Surgery, and bUnit of Digestive Endoscopy, Hospital de Sant Pau, University of Barcelona, Barcelona, Spain
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Article / Publication Details
Received: November 21, 2003
Accepted: April 02, 2004
Published online: October 06, 2004
Issue release date: October 2004
Number of Print Pages: 5
Number of Figures: 1
Number of Tables: 1
ISSN: 0253-4886 (Print)
eISSN: 1421-9883 (Online)
For additional information: https://www.karger.com/DSU
Abstract
Background: Obstruction of the left colon may be the first manifestation of colorectal cancer. Resection of the colonic segment involved and the construction of an end colostomy (Hartman’s procedure) is the most frequent treatment. Alternatives to the placement of a stoma are subtotal colectomy or intraoperative lavage of the colon and primary anastomosis, but their application depends on intraoperative findings and the availability of a skilled surgeon. The use of an expandable stent (SEMS) can enhance the feasibility of laparoscopic colectomy, avoiding the need for a colostomy and offering the advantages of a combination of two minimally invasive procedures. Study Design: Between 1997 and 2004, an SEMS was placed in 11 cases of left colonic obstruction due to cancer, the obstruction being successfully resolved in each case. Seven patients were approached by laparoscopy to attempt the definitive colectomy. We evaluated the location and pathological characteristics of the tumor, effectiveness and complications of SEMS insertion, time interval between the insertion of SEMS and laparoscopic surgery, and postoperative data. Results: The tumors were situated in the recto-sigma (1 case), sigma (3 cases) and descending colon (3 cases). Immediate relief of the obstruction was achieved in all cases after SEMS insertion of the stent, and oral diet was started at 24 h. The 7 patients were operated on an average of 8 days (range 6–14) after insertion of the stent. Conversion to open surgery was necessary in one case for reasons not related to the stent. Conclusions: Preliminary results of the combination of SEMS and elective laparoscopic surgery demonstrate that the procedure is feasible and that it presents all the clinical advantages of a minimally invasive approach. The procedure is a valid alternative to traditional major urgent surgery.
© 2004 S. Karger AG, Basel
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References
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Article / Publication Details
Received: November 21, 2003
Accepted: April 02, 2004
Published online: October 06, 2004
Issue release date: October 2004
Number of Print Pages: 5
Number of Figures: 1
Number of Tables: 1
ISSN: 0253-4886 (Print)
eISSN: 1421-9883 (Online)
For additional information: https://www.karger.com/DSU
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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