| Summary: | 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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