Stent Presentation at STS 2009 San francisco

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dubeczattila

My presentation at the Society of Thoracic Surgeons meeting in San Francisco in January of 2009

Health & Medicine

Esophageal Stenting for Malignant and Benign Disease: 133 Cases on a Thoracic Surgical Service A Dubecz, TJ Watson, A Matousek, J Allen, M Polomsky, R Salvador, CE Jones, DP Raymond, JH Peters Society of Thoracic Surgeons 45th Annual Meeting, January 26-28, 2009, San Francisco, CA Division of Thoracic and Foregut Surgery, Department of Surgery University of Rochester School of Medicine and Dentistry Rochester, NY

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Background ,[object Object],Blazeby et al. A prospective longitudinal study examining quality of life in patients with esophageal carcinoma. CANCER 2000 Frenken Best palliation in esophageal cancer: surgery, stenting, radiation or what? Diseases of Esophagus 2001.

Background ,[object Object],[object Object],[object Object],[object Object],Homs MY et al. Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. Lancet. 2004 Tumor persistence 18%, tumor regrowth 26%

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[object Object],[object Object],[object Object],[object Object],[object Object],Choice of Stent

Results ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],13 migrations in 12 patients (13/133; 9.7%)‏ Migration

Impaction ,[object Object],[object Object],[object Object]

Tumor Ingrowth ,[object Object],‏ ,[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Removable Stents

Conclusions ,[object Object],[object Object],[object Object],[object Object]

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Biliary stents become very important tools in the hands of gastro-intestinal endoscopists. They solve a lot of problems, but they are not free of copmlications. During insertion of a biliary stent in a sixty-five-year-old female patient it broke. It broke in a place which makes its retrieval very difficult. Trial of retrieval led to pushing of the stent deep into the common bile duct. It lies just below the mouth of the cystic duct, which should have made a warning for a rare migration. Later the stent was seen in the vicinity of the gallbladder during ERCP. Cholecystectomy was done and the stent was found inside it.

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Knowledge of the basic principles of bowel resection, anastomosis, and the stoma formation, will allow the gynecologist to competently manage many scenarios in which malignancies involve the bowel and require resection for restoration of bowel continuity. In patients with ramified pelvic tumours, a colorectal surgeon may be required as portion of the multidisciplinary approach to ensure complete removal of the cancer (Alves et al., 2004). The type of the intestinal anastomosis one performs depends on personnel preference but irrespective of the technique availed, principles that ensure a successful outcome include: good vascular supply to segments being specifically approximated, no distal obstruction, and a tension free repair. There are certain bowel disorders like bloating, colic pain etc (Sreeremya, 2018).

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