Advertisement

International Journal of Colorectal Disease

, Volume 22, Issue 11, pp 1377–1381 | Cite as

Laparoscopic colonoscopic rendezvous procedures for the treatment of polyps and early stage carcinomas of the colon

  • H. Winter
  • R. A. Lang
  • F. W. Spelsberg
  • K.-W. Jauch
  • T. P. Hüttl
Original Article

Abstract

Background and aims

Endoscopic treatment of large or colonoscopically inaccessible polyps or early stage tumors in the colon holds the risk of incomplete resection and colonic perforation. The combination of colonoscopy and laparoscopy offers a minimally invasive treatment modality for the complete resection of polyps with low risk. Aim of this study was to assess the feasibility and outcome of patients operated on by laparoendoscopic rendezvous procedures at the colon.

Materials and methods

The medical records of 38 patients (21 male, 17 female, median age 66 years [range 39–90]) undergoing rendezvous surgery at the colon were reviewed prospectively. Follow-up data were obtained by clinical examination and personal communication via telephone or questionnaire. The median follow up was 54 months.

Results

From January 1998 until April 2007, 38 patients were treated with rendezvous procedures in our hospital. In 30 cases, a colonoscopically assisted laparoscopic procedure was performed and in eight patients a laparoscopically controlled colonoscopic procedure. A benign lesion was confirmed histologically in 31 patients. In five cases, histopathologic diagnosis revealed a malignancy necessitating colonic surgery. A coprolith extraction and a suture of the sigma were performed in one case each. Complications occurred in two patients. One patient developed an anastomosis insufficiency that necessitated a revision. One patient developed pneumonia postoperatively. A conversion to laparotomy had to be performed in two cases.

Conclusion

Rendezvous procedures offer a safe, minimal-invasive therapeutic approach allowing the resection of benign sessile or colonoscopically inaccessible localized polyps and of early stage colon cancer.

Keywords

Polypectomy Laparoscopy Rendezvous procedure Colonoscopy Laparoendoscopy 

References

  1. 1.
    McDonald JM, Moonka R, Bell RH Jr (1999) Pathologic risk factors of occult malignancy in endoscopically unresectable colonic adenomas. Am J Surg 177:384–387CrossRefPubMedGoogle Scholar
  2. 2.
    Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond H, Panish JF (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 329:1977–1981CrossRefPubMedGoogle Scholar
  3. 3.
    Wichmann MW, Hüttl TP, Winter H, Spelsberg F, Angele MK, Heiss MM, Jauch K-W (2005) Immunological effects of laparoscopic vs open colorectal surgery: a prospective clinical study. Arch Surg 140:692–697CrossRefPubMedGoogle Scholar
  4. 4.
    Joo JS, Amarnath L, Wexner SD (1998) Is laparoscopic resection of colorectal polyps beneficial? Surg Endosc 12:1341–1344CrossRefPubMedGoogle Scholar
  5. 5.
    Anderson BO, Hann LE, Enker WE, Dershaw DD, Guillem JG, Cohen AM (1994) Transrectal ultrasonography and operative selection for early carcinoma of the rectum. J Am Coll Surg 179:513–517PubMedGoogle Scholar
  6. 6.
    Feussner H, Wilhelm D, Dotzel V, Papagoras D, Frimberger E (2003) Combined endoluminal and endocavitary approaches to colonic lesions. Surg Technol Int 11:97–101PubMedGoogle Scholar
  7. 7.
    Bond JH (1993) Polyp guideline: diagnosis, treatment, and surveillance for patients with nonfamilial colorectal polyps. The Practice Parameters Committee of the American College of Gastroenterology. Ann Intern Med 119:836–843CrossRefPubMedGoogle Scholar
  8. 8.
    Church JM (2003) Experience in the endoscopic management of large colonic polyps. ANZ J Surg 73:988–995CrossRefPubMedGoogle Scholar
  9. 9.
    Church JM (2003) Avoiding surgery in patients with colorectal polyps. Dis Colon Rectum 46:1513–1516CrossRefPubMedGoogle Scholar
  10. 10.
    Dell’Abate P, Iosca A, Galimberti A, Piccolo P, Soliani P, Foggi E (2001) Endoscopic treatment of colorectal benign-appearing lesions 3 cm or larger: techniques and outcome. Dis Colon Rectum 44:112–118CrossRefPubMedGoogle Scholar
  11. 11.
    Doniec JM, Lohnert MS, Schniewind B, Bokelmann F, Kremer B, Grimm H (2003) Endoscopic removal of large colorectal polyps: prevention of unnecessary surgery? Dis Colon Rectum 46:340–348CrossRefPubMedGoogle Scholar
  12. 12.
    Nivatvongs S (1988) Complications in colonoscopic polypectomy: lessons to learn from an experience with 1576 polyps. Am Surg 54:61–63PubMedGoogle Scholar
  13. 13.
    Nusko G, Mansmann U, Altendorf-Hofmann A, Groitl H, Wittekind C, Hahn EG (1997) Risk of invasive carcinoma in colorectal adenomas assessed by size and site. Int J Colorectal Dis 12:267–271CrossRefPubMedGoogle Scholar
  14. 14.
    Eijsbouts QA, Heuff G, Sietses C, Meijer S, Cuesta MA (1999) Laparoscopic surgery in the treatment of colonic polyps. Br J Surg 86:505–508CrossRefPubMedGoogle Scholar
  15. 15.
    Young-Fadok TM, Radice E, Nelson H, Harmsen WS (2000) Benefits of laparoscopic-assisted colectomy for colon polyps: a case-matched series. Mayo Clin Proc 75:344–348CrossRefPubMedGoogle Scholar
  16. 16.
    Champault GG (1994) Laparoscopy and colonoscopy-assisted resection of polypoid colonic tumor. Surg Laparosc Endosc 4:382–383CrossRefPubMedGoogle Scholar
  17. 17.
    Prohm P, Weber J, Bonner C (2001) Laparoscopic-assisted coloscopic polypectomy. Dis Colon Rectum 44:746–748CrossRefPubMedGoogle Scholar
  18. 18.
    Smedh K, Skullman S, Kald A, Anderberg B, Nystrom P (1997) Laparoscopic bowel mobilization combined with intraoperative colonoscopic polypectomy in patients with an inaccessible polyp of the colon. Surg Endosc 11:643–644CrossRefPubMedGoogle Scholar
  19. 19.
    Averbach M, Cohen RV, de Barros MV, Kawahara NT, Ferreira EA, Pereira PR, Tolosa E (1995) Laparoscopy-assisted colonoscopic polypectomy. Surg Laparosc Endosc 5:137–138PubMedGoogle Scholar
  20. 20.
    Botoman VA, Pietro M, Thirlby RC (1994) Localization of colonic lesions with endoscopic tattoo. Dis Colon Rectum 37:775–776CrossRefPubMedGoogle Scholar
  21. 21.
    Reissman P, Teoh TA, Piccirillo M, Nogueras JJ, Wexner SD (1994) Colonoscopic-assisted laparoscopic colectomy. Surg Endosc 8:1352–1353PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Department of Surgery, Klinikum GroßhadernUniversity of MunichMunichGermany
  2. 2.Department of Surgery, Klinikum GroßhadernLudwig Maximilians UniversityMunichGermany

Personalised recommendations