Skip to main content

Advertisement

Log in

Intraoperative colonoscopy does not worsen the outcomes of laparoscopic colorectal surgery: a case-matched study

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Intraoperative colonoscopy is sometimes needed as an adjunct to colorectal surgery. When it is performed with laparoscopic surgery, there is the potential for prolonged bowel distension, obstructed surgical exposure, and increased morbidity. This study aimed to evaluate the overall safety and outcomes of laparoscopic colorectal procedures in which intraoperative colonoscopy was performed.

Methods

The study group consisted of patients who underwent intraoperative colonoscopy during laparoscopic intestinal resection at our institution between 1995 and 2011. They were individually matched for a number of factors including age, gender, diagnosis, American Society of Anesthesiologists (ASA) physical status score, and type of surgical procedure with a cohort of patients who underwent laparoscopic intestinal resection with no intraoperative colonoscopy during the same period. Early postoperative outcomes and time to flatus and first bowel movement were compared.

Results

For the study, 30 patients (18 females) and 30 matched control subjects were identified. The study and control groups did not differ in terms of operating time (132 vs 151 min; p = 0.5), estimated blood loss (216 vs 212 ml; p = 0.9), conversion to open surgery (n = 1 vs 5; p = 0.2), time to first flatus (3 vs 4 days; p = 0.4), time to first bowel movement (4 vs 4 days; p = 0.4), reoperation (n = 0 vs 1; p = 1), length of hospital stay (6 vs 9 days; p = 0.3), overall morbidity (n = 10 vs 14; p = 0.4), or readmission (n = 0 vs 1; p = 1). The complications that developed during or after surgery were similar in the two groups. No colonoscopy-related complications or deaths occurred.

Conclusions

Intraoperative colonoscopy does not complicate the application and outcomes of laparoscopic intestinal resection. Surgeons should perform an intraoperative colonoscopy when it is indicated during laparoscopic surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Louis MA, Nandipati K, Astorga R, Mandava A, Rousseau CP, Mandava N (2010) Correlation between preoperative endoscopic and intraoperative findings in localizing colorectal lesions. World J Surg 34:1587–1591

    Article  PubMed  Google Scholar 

  2. Brullet E, Montané JM, Bombardó J, Bonfill X, Noguè M, Bordas JM (1992) Intraoperative colonoscopy in patients with colorectal cancer. Br J Surg 79:1376–1378

    Article  PubMed  CAS  Google Scholar 

  3. Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 359:2224–2229

    Article  PubMed  Google Scholar 

  4. Zimmern A, Prasad L, Desouza A, Marecik S, Park J, Abcarian H (2010) Robotic colon and rectal surgery: a series of 131 cases. World J Surg 34:1954–1958

    Article  PubMed  Google Scholar 

  5. Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 238:67–72

    PubMed  Google Scholar 

  6. Wexner SD, Cohen SM, Ulrich A, Reissman P (1995) Laparoscopic colorectal surgery: are we being honest with our patients? Dis Colon Rectum 38:723–727

    Article  PubMed  CAS  Google Scholar 

  7. Souma Y, Nakajima K, Takahashi T, Nishimura J, Fujiwara Y, Takiguchi S, Miyata H, Yamasaki M, Doki Y, Nishida T (2009) The role of intraoperative carbon dioxide insufflating upper gastrointestinal endoscopy during laparoscopic surgery. Surg Endosc 23:2228–2279

    Article  Google Scholar 

  8. Richter RM, Littman L, Levowitz BS (1973) Intraoperative fiberoptic colonoscopy: localization of nonpalpable colonic lesions. Arch Surg 106:228

    Article  PubMed  CAS  Google Scholar 

  9. Panaro F, Casaccia M, Cavaliere D, Torelli P (2003) Laparoscopic colon resection with intraoperative polyp localisation with high-resolution ultrasonography coupled with colour power Doppler. Postgrad Med J 79:533–534

    Article  PubMed  CAS  Google Scholar 

  10. Ohdaira T, Nagai H, Shoji M (2003) Intraoperative localization of colorectal tumors in the early stages using a magnetic marking clip detector system (MMCDS). Surg Endosc 17:692–695

    Article  PubMed  CAS  Google Scholar 

  11. Cho YB, Lee WY, Yun HR, Lee WS, Yun SH, Chun HK (2007) Tumor localization for laparoscopic colorectal surgery. World J Surg 31:1491–1495

    Article  PubMed  Google Scholar 

  12. North JH Jr, Rodriguez-Bigas MA, Petrelli NJ (1998) Intraoperative endoscopy in the management of patients with colorectal disease. Cancer Invest 16:1–5

    Article  PubMed  Google Scholar 

  13. Zmora O, Dinnewitzer AJ, Pikarsky AJ, Efron JE, Weiss EG, Nogueras JJ, Wexner SD (2002) Intraoperative endoscopy in laparoscopic colectomy. Surg Endosc 16:808–811

    Article  PubMed  CAS  Google Scholar 

  14. Kim SH, Milsom JW, Church JM, Ludwig KA, Garcia-Ruiz A, Okuda J, Fazio VW (1997) Perioperative tumor localization for laparoscopic colorectal surgery. Surg Endosc 11:1013–1016

    Article  PubMed  CAS  Google Scholar 

  15. Montorsi M, Opocher E, Santambrogio R, Bianchi P, Faranda C, Arcidiacono P, Passoni GR, Cosentino F (1999) Original technique for small colorectal tumor localization during laparoscopic surgery. Dis Colon Rectum 42:819–822

    Article  PubMed  CAS  Google Scholar 

  16. Brandt LJ, Boley SJ, Sammartano R (1986) Carbon dioxide and room air insufflation of the colon: effects on colonic blood flow and intraluminal pressure in the dog. Gastrointest Endosc 32:324–329

    Article  PubMed  CAS  Google Scholar 

  17. Lanthaler M, Biebl M, Mittermair R, Ofner D, Nehoda H (2008) Intraoperative colonoscopy for anastomosis assessment in laparoscopically assisted left-sided colon resection: is it worthwhile? J Laparoendosc Adv Surg Tech A 18:27–31

    Article  PubMed  Google Scholar 

  18. Park YA, Jung EJ, Han SJ (2005) Laparoscopic resection of duplicated sigmoid colon under the guidance of intraoperative colonoscopy. Surg Laparosc Endosc Percutan Tech 15:299–301

    Article  PubMed  Google Scholar 

  19. Wilhelm D, von Delius S, Weber L, Meining A, Schneider A, Friess H, Schmid RM, Frimberger E, Feussner H (2009) Combined laparoscopic-endoscopic resections of colorectal polyps: 10-year experience and follow-up. Surg Endosc 23:688–693

    Article  PubMed  Google Scholar 

  20. Smedh K, Skullman S, Kald A, Anderberg B, Nyström P (1997) Laparoscopic bowel mobilization combined with intraoperative colonoscopic polypectomy in patients with an inaccessible polyp of the colon. Surg Endosc 11:643–644

    Article  PubMed  CAS  Google Scholar 

  21. Mohiuddin SS, Gonzalez JJ, Glass J, Portillo G, Franklin ME Jr (2009) Laparoscopic-assisted endoluminal hybrid surgery: a stepping stone to NOTES. Surg Laparosc Endosc Percutan Tech 19:474–478

    Article  PubMed  Google Scholar 

  22. Nakajima K, Lee SW, Sonoda T, Milsom JW (2005) Intraoperative carbon dioxide colonoscopy: a safe insufflation alternative for locating colonic lesions during laparoscopic surgery. Surg Endosc 19:321–325

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The study was supported by the Ed and Joey Story Endowed Chair in Colorectal Surgery.

Disclosures

I. Emre Gorgun, Erman Aytac, Elena Manilich, James M. Church, and Feza H Remzi have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to I. Emre Gorgun.

Additional information

Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, TX, 2–6 June 2012.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gorgun, I.E., Aytac, E., Manilich, E. et al. Intraoperative colonoscopy does not worsen the outcomes of laparoscopic colorectal surgery: a case-matched study. Surg Endosc 27, 3572–3576 (2013). https://doi.org/10.1007/s00464-013-2928-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-013-2928-1

Keywords

Navigation