Use of covered self-expandable stents for benign colorectal disorders in children

Bettina Lange; Moritz Sold; Georg Kähler; Lucas M Wessel; Rainer Kubiak

doi:10.1016/j.jpedsurg.2016.01.020

Use of covered self-expandable stents for benign colorectal disorders in children

J Pediatr Surg. 2017 Jan;52(1):184-187. doi: 10.1016/j.jpedsurg.2016.01.020. Epub 2016 Mar 4.

Authors

Bettina Lange¹, Moritz Sold², Georg Kähler², Lucas M Wessel³, Rainer Kubiak³

Affiliations

¹ Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Department of Pediatric Surgery, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany. Electronic address: bettina.lange@umm.de.
² Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Central Interdisciplinary Endoscopy, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany.
³ Medical Faculty Mannheim, Heidelberg University, University Medical Center Mannheim, Department of Pediatric Surgery, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany.

PMID: 26947402
DOI: 10.1016/j.jpedsurg.2016.01.020

Abstract

Purpose: There is a lack of experience with covered self-expandable stents for benign colorectal disorders in children.

Methods: Five children (4M, 1F) with a median age of 5years (range, 6months-9years) who underwent treatment with covered self-expandable plastic (SEPSs) or self-expandable metal stents (SEMSs) for a benign colorectal condition between April 2005 and November 2013 were recruited to this retrospective study. Etiologies included: anastomotic stricture with (n=1) or without (n=3) simultaneous enterocutaneous fistula, as well as an anastomotic leak associated with enterocutaneous fistula (n=1). All children suffered from either Hirschsprung's disease (n=3) or total colonic aganglionosis (Zuelzer-Wilson syndrome) (n=2).

Results: Median duration of individual stent placement was 23days (range, 1-87days). In all cases up to five different stents were placed over time. At follow-up two patients were successfully treated without further intervention. In another patient the anastomotic stricture resolved fully, but a coexisting enterocutaneous fistula persisted. Overall, three patients did not improve completely following stenting and required definite surgery. Stent-related problems were noted in all cases. There was one perforation of the colon at stent insertion. Further complications consisted of stent dislocation (n=4), obstruction (n=1), formation of granulation tissue (n=1), ulceration (n=1) and discomfort (n=3).

Conclusions: Covered self-expandable stents enrich the armamentarium of interventions for benign colorectal disorders in children including anastomotic strictures and intestinal leaks. A stent can be applied either as an emergency procedure (bridge to surgery) or as an adjuvant treatment further to endoscopy and dilatation. Postinterventional problems are frequent but there is a potential for temporary or definite improvement following stent insertion.

Keywords: Children; Covered self-expandable stents; Hirschsprung's disease; Intestinal stricture; Total colonic aganglionosis.

MeSH terms

Child
Child, Preschool
Coated Materials, Biocompatible*
Colon / surgery*
Colonic Diseases / surgery*
Digestive System Surgical Procedures / methods*
Female
Humans
Infant
Male
Prosthesis Design
Rectal Diseases / surgery*
Rectum / surgery*
Retrospective Studies
Self Expandable Metallic Stents*
Treatment Outcome

Substances

Coated Materials, Biocompatible