Comparison of Laparoscopic versus Open Surgery after Insertion of Self-Expandable Metallic Stents in Acute Malignant Colorectal Obstruction: A Case-Matched Study

Authors

  • Vitoon Chinswangwatanakul Minimally Invasive Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700
  • Chotirot Angkurawaranon Department of Surgery, Rajavithi Hospital, Bangkok 10400
  • Atthaphorn Trakarnsanga Minimally Invasive Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700
  • Jirawat Swangsri Minimally Invasive Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700
  • Chainarong Phalanusithepha Minimally Invasive Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700
  • Thawatchai Akaraviputh Minimally Invasive Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700

Keywords:

Self-expanding metallic stent (SEMS), malignant colorectal obstruction, laparoscopic, bridge to surgery, primary anastomosis, ostomy

Abstract

Background: Self-expanding metallic stents (SEMS) have been acknowledged in management of acute colorectal obstruction. The surgical approach after SEMS insertion varies from open approach to laparoscopic-assisted approach. The primary objective of this study was to compare the outcomes of laparoscopic approach and open approach after SEMS insertion.
Methods: From January 2007 to December 2010, cross-sectional medical records reviewed a total of 76 patients who underwent colorectal stenting with SEMS. Patients and tumor characteristics, complications, morbidity and mortality were obtained.
Results: Forty-three patients underwent SEMS placement as a bridge to surgery. Laparoscopic-assisted surgery (LS) was performed in 24 patients (55.8%), and open surgery (OS) was performed in 19 patients (44.2%). All clinicopathological parameters were matched. The technical success of SEMS was found in 42 patients (97.7%), and the clinical stent success was 100%. LS had a higher chance of primary anastomosis than OS (p=0.012; Odd ratio 2.717; 95%CI: 1.79-4.012). LS had a lower permanent ostomy rate (p=0.031; Odd ratio 0.385; 95%CI: 0.259-0.572) and lower estimated blood loss (p=0.024; Odd ratio 0.23; 95%CI: 0.006-0.086). The post-operative complications, mortality rate, recurrence rate, disease free status, and overall survival rates between the two groups were non-significant. 
Conclusion: Colonic stent is an effective treatment of acute malignant colonic obstruction. The authors suggest the advantage of laparoscopic approach resection after colonic stenting results in a higher primary anastomosis rate, and lower blood loss than open surgery. 

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Published

24-03-2017

How to Cite

Chinswangwatanakul, V., Angkurawaranon, C., Trakarnsanga, A., Swangsri, J., Phalanusithepha, C., & Akaraviputh, T. (2017). Comparison of Laparoscopic versus Open Surgery after Insertion of Self-Expandable Metallic Stents in Acute Malignant Colorectal Obstruction: A Case-Matched Study. Siriraj Medical Journal, 69(2), 57–64. Retrieved from https://he02.tci-thaijo.org/index.php/sirirajmedj/article/view/80891

Issue

Vol. 69 No. 2 (2017): March-April

Section

Original Article

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