Feasibility of a single-stage operation consisting of self-expandable metallic stent implantation followed by laparoscopic surgery for obstructive left colon obstruction

Objective To investigate the feasibility of a single-stage operation consisting of self-expandable metallic stent (SEMS) implantation followed by laparoscopic surgery for colorectal obstruction.Methods The clinical data of 21 patients with colorectal obstruction who received SEMS implantation at the Shanghai Tenth People's Hospital from October 2009 to November 2011 were retrospectively analyzed.The SEMS placement,colorectal obstruction,disease remission rate and the outcome of laparoscopic surgery were analyzed.All data were analyzed using the Fisher exact probability.Results SEMS was successfully implanted in 17 patients,and colorectal obstruction was alleviated within 24 hours.The levels of albumin and hemoglobin were back to normal,and acid-base disturbance,water electrolyte disorder were rectified.The symptoms of hypertension,diabetes,myocardial ischemia and pulmonary infection were alleviated,and the anesthesia risk was significantly reduced (P ＜ 0.05).There were no significant difference in the alleviation of arrhythmia and chronic obstructive pulmonary disease (P ＞0.05).Of the 4 patients who were failed in SEMS implantation,1 patient had colonic perforation caused by stents,and the other 3 patients had complete colorectal obstruction,and they were converted to Hartmann procedure.Laparoscopic colorectal resection was completed successfully in the 17 patients who had remission of colorectal obstruction.The operation time,volume of blood lose,distance from distal resection margin to tumor,length of incision were (142 ± 38) minutes,(29 ± 11) mL,(3.8 ± 0.3) cm and (6.2 ±2.8)cm,respectively.No anastomotic fistula occurred.The time to anal exhaust time,time to food intake and postoperative hospital stay were (2.4 ±0.6)days,(3.8 ± 1.6) days,(17 ± 4) days,respectively.The 21 patients were followed up for 6 months to 2 years,1 patient died of cerebral vascular bleeding;2 patients had hepatic metastasis and they received chemotherapy;18 patients were sound and well.Conclusion A single-stage operation consisting of SEMS placement followed by laparoscopic surgery is a feasible and safe treatment option for patients with colorectal obstruction. Key words: Colonic neoplasms ;  Rectal neoplasms ; Obstruction;  Laparoscopy ;  Stent implantation