Ayako Otsuji

Outcome of 141 cases of self-expandable metallic stent placements for malignant and benign colorectal strictures in a single center

BackgroundThe use of a self-expandable metallic stent (SEMS) has emerged as an alternative treatment option for malignant colorectal obstruction. Although the technical success rate of SEMS has been widely reported, outcome data are limited.MethodsThis retrospective study evaluated the short- and long-term outcomes of colorectal SEMS for malignant and benign disease in patients who underwent SEMS at a single center.ResultsOne surgeon inserted all stents under endoscopic and fluoroscopic guidance; 141 SEMS procedures were performed in 133 patients (82 males, mean age 69 years). The SEMS procedure was undertaken for: palliation of malignant obstruction in 30 patients (36 cases), and the technical success rate was 94%; a bridge to surgery for colorectal cancers in 98 patients/cases, and the technical success rate was 91%; benign stricture in 5 patients (7 cases), and the technical success rate was 100%. Due to anatomical differences, the success rate was lower at the cecum, descending colon, and sigmoid than in the rectosigmoid and rectum. In 11 cases of technical failures, the failures were due to technical problems in 9 cases (82%) and due to the state of the stricture in 2 cases (18%). Procedure-related complications occurred in 6 patients (4%): perforation in 3 and migration in 3. All perforation cases and one migration case underwent emergency surgery. There was no mortality. In the bridge to surgery group, postoperative complications were much lower in the clinical success cases (6%) than in the failure group (36%). In the palliation treatment group, long-term SEMS migration occurred in 4 patients (14%), and re-obstruction occurred in 5 patients (18%); the mean insertion period was 201 (range: 10–576) days.ConclusionsColorectal SEMS had feasible short and long-term results and low morbidity, making it a viable option for various types of colorectal obstruction with careful attention to the indications.

Pericardial effusion can be a critical complication after laparoscopic hernia repair using mesh and stapler for Morgagni hernia

Abstract Introduction: Several cases of Morgagni hernia have recently been treated with laparoscopic mesh repair, which is reported to have fewer complications and to be less invasive. Here we describe a case of a laparoscopic Morgagni hernia repair treated with mesh that progressed to heart failure due to pericardial effusion 2 months after hospital discharge. Case Presentation: A 78-year-old woman was incidentally found to have a Morgagni hernia during a routine chest X-ray. The laparoscopic Morgagni hernia repair was performed using Composix mesh○R and an ENDOPATH○R EMS Stapler. The Composix mesh○R was gently attached to the surface of the diaphragm using the ENDOPATH○R EMS Stapler. She was discharged from the hospital on the 7th postoperative day without any adverse events. However, 2 months later, she developed dyspnea due to heart failure secondary to a pericardial effusion. Pericardial drainage was performed during her hospitalization, and she was discharged 7 days later. No recurrence of either th...