Introduction. Colorectal anastomotic leak or stricture is a dreaded complication leading to significant morbidity and mortality. The novel use of self-expandable metal stents (SEMS) in the management of postoperative colorectal anastomotic leaks or strictures can avoid surgical reintervention. Methods. Retrospective study with particular attention to the indications, operative or postoperative complications, and clinical outcomes of SEMS placement for patients with either a colorectal anastomotic stricture or leak. Results. Eight patients had SEMS (WallFlex stent) for the management of postoperative colorectal anastomotic leak or stricture. Five had a colorectal anastomotic stricture and 3 had a colorectal anastomotic leak. Complete resolution of the anastomotic stricture or leak was achieved in all patients. Three had recurrence of the anastomotic stricture on 3-month flexible sigmoidoscopy follow-up after the initial stent was removed. Two of these patients had a stricture that was technically too difficult to place another stent. Stent migration was noted in 2 patients, one at day 3 and the other at day 14 after stent placement that required a larger 23？mm stent to be placed. Conclusions. The use of SEMS in the management of colorectal anastomotic leaks or strictures is feasible and is associated with high technical and clinical success rate. 1. Introduction Anastomotic adverse events after partial colectomy include bleeding, leaks, fistulas, or strictures. Anastomotic leaks or strictures are a dreaded adverse event of colorectal surgery that can lead to a prolonged hospital stay and significant morbidity and mortality. An anastomotic leak is defined as a defect of the intestinal wall at the anastomotic site leading to a communication between the intra/extraluminal compartments [1]. The risk varies with the site of the anastomosis with those placed less than 5 centimeters (cm) from the anal verge being particularly vulnerable [2]. The incidence of an anastomotic leak depends on the location of the anastomosis with the highest incidence of 10–20% occurring with colorectal anastomosis [3]. The majority of patients suspected of having an anastomotic leak based on clinical assessment will undergo imaging studies to confirm the diagnosis. The usual approach for management of postoperative anastomotic leaks includes intravenous antibiotics, bowel rest, percutaneous drainage, parenteral nutrition, and surgical diversion [4]. The patient may require reoperation that consists of taking down the anastomosis and creation of an end colostomy. The distal portion
References
[1]
B. D. Shogan, E. M. Carlisle, J. C. Alverdy, and K. Umanskiy, “Do we really know why colorectal anastomoses leak?” Journal of Gastrointestinal Surgery, vol. 17, no. 9, pp. 1698–1707, 2013.
[2]
N. A. Hirst, J. P. Tiernan, P. A. Millner, and D. G. Jayne, “Systematic review of methods to predict and detect anastomotic leakage in colorectal surgery,” Colorectal Disease, vol. 16, no. 2, pp. 95–109, 2014.
[3]
P. G. A. van Boeckel, K. S. Dua, B. L. A. M. Weusten et al., “Fully covered self-expandable metal stents (SEMS), partially covered SEMS and self-expandable plastic stents for the treatment of benign esophageal ruptures and anastomotic leaks,” BMC Gastroenterology, vol. 12, article 19, 2012.
[4]
C. J. DiMaio, M. P. Dorfman, G. J. Gardner et al., “Covered esophageal self-expandable metal stents in the nonoperative management of postoperative colorectal anastomotic leaks,” Gastrointestinal Endoscopy, vol. 76, no. 2, pp. 431–435, 2012.
[5]
D. Fraccalvieri, S. Biondo, J. Saez et al., “Management of colorectal anastomotic leakage: differences between salvage and anastomotic takedown,” The American Journal of Surgery, vol. 204, no. 5, pp. 671–676, 2012.
[6]
P. H. Kim, H.-Y. Song, J.-H. Park, J. H. Kim, H. K. Na, and Y. J. Lee, “Safe and effective treatment of colorectal anastomotic stricture using a well-defined balloon dilation protocol,” Journal of Vascular and Interventional Radiology, vol. 23, no. 5, pp. 675–680, 2012.
[7]
K. L. Suchan, A. Muldner, and B. C. Manegold, “Endoscopic treatment of postoperative colorectal anastomotic strictures,” Surgical Endoscopy and Other Interventional Techniques, vol. 17, no. 7, pp. 1110–1113, 2003.
[8]
L. Amrani, C. Ménard, S. Berdah et al., “From iatrogenic digestive perforation to complete anastomotic disunion: endoscopic stenting as a new concept of “stent-guided regeneration and re-epithelialization”,” Gastrointestinal Endoscopy, vol. 69, no. 7, pp. 1282–1287, 2009.
[9]
L. Feo and D. M. Schaffzin, “Colonic stents: the modern treatment of colonic obstruction,” Advances in Therapy, vol. 28, no. 2, pp. 73–86, 2011.
[10]
A. Lamazza, E. Fiori, A. V. Sterpetti, A. Schillaci, D. Scoglio, and E. Lezoche, “Self-expandable metal stents in the treatment of benign anastomotic stricture after rectal resection for cancer,” Colorectal Disease, vol. 16, no. 4, pp. O150–O153, 2014.
[11]
A. Repici, D. Reggio, C. De Angelis et al., “Covered metal stents for management of inoperable malignant colorectal strictures,” Gastrointestinal Endoscopy, vol. 52, no. 6, pp. 735–740, 2000.
[12]
K. Tominaga, M. Yoshida, I. Maetani, and Y. Sakai, “Expandable metal stent placement in the treatment of a malignant anastomotic stricture of the transverse colon,” Gastrointestinal Endoscopy, vol. 53, no. 4, pp. 524–527, 2001.
[13]
A. Mahajan, M. Rothermich, M. Gaidhane, and M. Kahaleh, “Esophageal self-expandable metal stent for an anastomotic colorectal stricture,” Endoscopy, vol. 43, no. 2, pp. E415–E416, 2011.
[14]
A. Currie, C. Christmas, H. Aldean, M. Mobasheri, and I. T. M. Bloom, “Systematic review of self-expanding stents in the management of benign colorectal obstruction,” Colorectal Disease, vol. 16, no. 4, pp. 239–245, 2013.
[15]
G. Vanbiervliet, P. Bichard, J.-F. Demarquay et al., “Fully covered self-expanding metal stents for benign colonic strictures,” Endoscopy, vol. 45, no. 1, pp. 35–41, 2013.
[16]
M. A. Abbas, “Endoscopic management of acute colorectal anastomotic complications with temporary stent,” Journal of the Society of Laparoendoscopic Surgeons, vol. 13, no. 3, pp. 420–424, 2009.
[17]
H.-Y. Song, J. H. Kim, K. R. Kim et al., “Malignant rectal obstruction within 5 cm of the anal verge: is there a role for expandable metallic stent placement?” Gastrointestinal Endoscopy, vol. 68, no. 4, pp. 713–720, 2008.
