Endoscopic placement of self-expanding stents in patients with symptomatic anastomotic leakage after colorectal resection for cancer: long-term results

Antonietta Lamazza; Antonio V. Sterpetti; Alessandro De Cesare; Alberto Schillaci; Angelo Antoniozzi; Enrico Fiori

doi:10.1055/s-0034-1391403

Endoscopy, Inhaltsverzeichnis

Endoscopy 2015; 47(03): 270-272
DOI: 10.1055/s-0034-1391403

Case series

Endoscopic placement of self-expanding stents in patients with symptomatic anastomotic leakage after colorectal resection for cancer: long-term results

Antonietta Lamazza

Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy

,

Antonio V. Sterpetti

Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy

,

Alessandro De Cesare

Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy

,

Alberto Schillaci

Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy

,

Angelo Antoniozzi

Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy

,

Enrico Fiori

Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy

› Institutsangaben

Abstract

Anastomotic leak after colorectal resection for cancer is a challenging clinical problem. The postoperative quality of life in these situations is significantly impaired. We prospectively analyzed the effect of placing a self-expanding metal stent (SEMS) at the level of the leak, with or without proximal diverting ileostomy, in 22 patients with symptomatic anastomotic leakage after colorectal resection. The stents were placed successfully in all 22 patients. An proximal ileostomy was created in 15 patients under general anesthesia. The anastomotic leak healed, without evidence of residual stricture or major incontinence, in 19 patients (86 %). In 3 patients, the leak did not heal; in 2 patients with recurrent rectovaginal fistula, the size of the leak decreased significantly, allowing successful flap transposition; and only 1 patient required a permanent stoma. SEMS placement is a valid adjunct to the treatment of patients with symptomatic anastomotic leakage after colorectal resection.

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Referenzen

References
1 Baron TH. Colonic stenting: a palliative measure only or a bridge to surgery?. Endoscopy 2010; 42: 163-168
2 Song HY, Kim JH, Shin JH et al. A dual-design expandable colorectal stent for malignant colorectal obstruction: results of a multicenter study. Endoscopy 2007; 39: 448-454
3 Lamazza A, Fiori E, Schillaci A et al. Treatment of anastomotic stenosis and leakage after colorectal resection for cancer with self-expandable metal stents. Am J Surg 2014; 208: 465-469 Epub 2014 Jan 17
4 Caulfield H, Hyman NH. Anastomotic leak after low anterior resection: a spectrum of clinical entities. JAMA Surg 2013; 148: 177-182
5 Sirois-Giguere E, Boulanger-Gobeil C, Bouchard A et al. Transanal drainage to treat leaks after anterior resection for rectal cancer: a valuable option. Dis Colon Rectum 2013; 56: 586-592
6 Reinke CE, Showalter S, Mahmoud NN et al. Comparison of anastomotic leak rate after colorectal surgery using different databases. Dis Colon Rectum 2013; 56: 638-644
7 Morks AN, Ploeg RJ, Sijbrand Hofker H et al. Late anastomotic leakage in colorectal surgery: a significant problem. Colorectal Dis 2013; 15: e271-e275
8 Ashburn JH, Stocchi L, Kiran RP et al. Consequences of anastomotic leak after restorative proctectomy for cancer; effect on long-term function and quality of life. Dis Colon Rectum 2013; 56: 275-280
9 Marinatou A, Theodoropoulos GE, Karanika S et al. Do anastomotic leaks impair postoperative health-related quality of life after rectal cancer surgery? A case-matched study. Dis Colon Rectum 2014; 57: 158-166
10 Genser L, Manceau G, Karoui M et al. Postoperative and long-term outcomes after redo surgery for failed colorectal and coloanal anastomosis; retrospective analysis of 50 patients and review of the literature. Dis Colon Rectum 2013; 56: 747-755