Abstract
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.
Highlights
Colorectal anastomotic leak or stricture is a dreaded complication leading to significant morbidity and mortality
We present our experience with the temporary placement of covered esophageal self-expandable metal stents (SEMS) in the nonoperative management of benign postoperative colorectal anastomotic leaks or strictures
A retrospective medical chart review was performed on all patients that had a covered self-expandable esophageal stent (CSEMS) placed for either a colorectal anastomotic stricture or leak at the Texas Tech University Health Sciences Center of El Paso Affiliated Hospital, University Medical Center of El Paso
Summary
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. 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. Eight patients had SEMS (WallFlex stent) for the management of postoperative colorectal anastomotic leak or stricture. 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. 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. Postoperative patients with a colorectal anastomotic leak have a mortality rate of 25–35% [5]
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