Laparoscopic assisted insertion of a colonic self-expandable metallic stent

Abstract

The self-expandable metallic stent (SEMS) was first invented in 1991 to relieve acute colonic obstruction by malignancy with a palliative intent [1]. The current indications for colonic stents are palliation of large bowel obstruction and bridge to surgery [2]. There are controversies about the latter indication, particularly related to its effects on outcomes [3]. For those who are old and frail, an extensive resection is not an option. The remaining treatment choices are SEMS or colostomy. These two choices seem to have equivalent efficacy [4]. Patients who have colonic SEMS have a shorter length of stay [5] and less early complications [6]. Despite the advantages of palliative colonic SEMS, there is up 50% failure due to technical difficulties in stent deployment [7]. The majority of cases of had failed stent insertion were due to the acute angulation of the colon [8]. When colostomy is a relative contraindication, as in patients with dementia or severe arthritis, failed stent insertion poses a clinical dilemma. We developed a novel technique of palliative colonic SEMS insertion with laparoscopic assistance to resolve this dilemma.