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Laparoscopic Approach to Colonic Perforation due to Colonoscopy

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Abstract

Background

Iatrogenic perforation due to colonoscopy is the most serious complication of this procedure. Usually, resolution of this event requires segmental resection. The laparoscopic approach could be an option to minimize the outcome of this complication. The aim of the present study was to assess the effectiveness of the laparoscopic approach in treating colonic perforations due to colonoscopy.

Methods

Between July 1997 and November 2008 data were collected retrospectively on all patients who underwent colonoscopy and had a perforation caused by the procedure. Patients with other complications after colonoscopy as well as other colonic perforations were excluded. According to the method employed for the approach, the series was divided in two groups: those treated by the laparoscopic approach (group I; GI) and those treated via laparotomy (group II; GII). Morbidity and recovery parameters were compared between the two groups. Statistical analysis was performed using Student’s t-test and the chi square test.

Results

A total of 14,713 colonoscopies were performed during the study period. Of these, 10,299 (73 %) were diagnostics and 4,414 (27%) were therapeutics. There were 20 (0.13%) iatrogenic perforations (GI = 14 versus GII = 6). The mean age of the patients was 62 ± 12.1 years. There were no differences in patient demographics, co-morbidities, and American Society of Anesthesiologists (ASA) grades between the groups. Seventeen patients had segmental colectomy with primary anastomosis (GI: 13 versus GII: 4). One patient in each group had simple suture with diverting ileostomy, and one patient from GII underwent a Hartmann’s procedure. Patients from GI had a shorter hospital stay (GI: 4.2 ± 2.06 days versus GII 11.5 ± 8.8 days; P = 0.007) and there were no differences in complication rate compared with GII (GI: 3 versus GII: 5; P = 0.058).

Conclusions

Laparoscopic colectomy is effective in resolving colonic perforation due to colonoscopy, and it might offer benefits over the open approach.

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References

  1. Carpio G, Albu E, Gumbs M et al (1989) Management of colonic perforation after colonoscopy. Report of three cases. Dis Colon Rectum 32:624–626

    Article  CAS  PubMed  Google Scholar 

  2. Cobb WS, Heniford BT, Sigmon LB et al (2004) Colonoscopic perforations: incidence, management and outcomes. Surg 70:757–758

    Google Scholar 

  3. Gatto NM, Frucht H, Sundararajan V et al (2003) Risk of perforation after colonoscopy and sigmoidoscopy: a population based study. J Natl Cancer Inst 95:230–235

    Article  PubMed  Google Scholar 

  4. Luning TH, Keemeres-Gels ME, Barendregt WB et al (2007) Colonoscopic perforations: a review of 30.366 patients. Surg Endosc 21:994–997

    Article  CAS  PubMed  Google Scholar 

  5. Magdeburg R, Collet P, Post S et al (2007) Endoclipping of iatrogenic colonic perforation to avoid surgery. Surg Endosc 22:1500–1504

    Article  PubMed  Google Scholar 

  6. Miyahara M, Kitano S, Shimoda K et al (1996) Laparoscopic repair of a colonic perforation sustained during colonoscopy. Surg Endosc 10:352–353

    Article  CAS  PubMed  Google Scholar 

  7. Putcha RV, Burdick S (2003) Management of iatrogenic perforation. Gastroenterol Clin North Am 32:1289–1309

    Article  PubMed  Google Scholar 

  8. Wullstein C, Koppen MO, Gross E (1999) Laparoscopic treatment of colonic perforations related to colonoscopy. Surg Endosc 13:484–487

    Article  CAS  PubMed  Google Scholar 

  9. Epstein O (2006) Complications of colonoscopy. BSG Guidelines in Gastroenterology 214–219. www.bsg.org.uk. Accessed March 2010

  10. Thomson SR, Fraser M, Stupp C et al (1994) Iatrogenic and accidental colon injuries—what to do? Dis Colon Rectum 37:496–502

    Article  CAS  PubMed  Google Scholar 

  11. Damore LJ, Rantis PC, Vernava AM et al (1996) Colonoscopic perforations. Etiology, diagnosis and management. Dis Colon Rectum 39:1308–1314

    Article  PubMed  Google Scholar 

  12. Iqbal CW, Chun YS, Farley DR (2005) Colonoscopic perforations: a retrospective review. J Gastrointest Surg 9:1229–1236

    Article  PubMed  Google Scholar 

  13. Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    Article  Google Scholar 

  14. Schlachta CM, Mamazza J, Gregoire R et al (2003) Could laparoscopic colon and rectal surgery become the standard of care? A review and experience with 750 procedures. J Can Chir 46:432–440

    Google Scholar 

  15. Tekkis PP, Senagore AJ, Delaney CP (2005) Comversion rates in laparoscopic colorectal surgery. A predictive model with 1253 patients. Surg Endosc 19:47–54

    Article  CAS  PubMed  Google Scholar 

  16. Agresta F, Michelet I, Mainente P et al (2000) Laparoscopic management of colonoscopic perforations. Surg Endosc 14:592–593

    CAS  PubMed  Google Scholar 

  17. Alfonso-Ballester R, Lopez-Mosos F, Marti-Obiol R et al (2006) Laparoscopic treatment of endoscopic sigmoid colon perforation. A case report and literature review. Surg Laparosc Endosc Percutan Tech 16:44–46

    Article  PubMed  Google Scholar 

  18. Di Marco L, Occhionorelli S, Schettino AM et al (1997) Laparoscopy in iatrogenic lesions of the colon during operative endoscopy. Ann Ital Chir 68:859–861

    CAS  PubMed  Google Scholar 

  19. Hansen AJ, Tessier DJ, Anderson ML et al (2007) Laparoscopic repair of colonoscopic perforations: indications and guidelines. J Gastrointest Surg 11:655–659

    Article  PubMed  Google Scholar 

  20. Mattei P, Alonso M, Justinich C (2005) Laparoscopic repair of colon perforation after colonoscopy in children: report of 2 cases and review of the literature. J Paeditatr Surg 40:1651–1653

    Article  Google Scholar 

  21. Pilgrim CH, Nottle PD (2007) Laparoscopic repair of iatrogenic colonic perforation. Surg Laparosc Endosc Percutan Tech 17:215–217

    Article  PubMed  Google Scholar 

  22. Velez MA, Riff DS, Mule JM (1997) Laparoscopic repair of a colonoscopic perforation. Surg Endosc 11:387–389

    Article  CAS  PubMed  Google Scholar 

  23. Yamamoto A, Ibusuki K, Koga K et al (2001) Laparoscopic repair of colonic perforation associated with colonoscopy: use of passing sutures and endoscopic linear stapler. Surg Laparosc Endosc Percutan Tech 11:19–21

    PubMed  Google Scholar 

  24. Araghizadeh FY, Timmcke AE, Opelka FG et al (2001) Colonoscopic perforations. Dis Colon Rectum 44:713–716

    Article  CAS  PubMed  Google Scholar 

  25. Vincent M, Smith LE (1983) Management of perforation due to colonoscopy. Dis Colon Rectum 26:61–63

    Article  CAS  PubMed  Google Scholar 

  26. Rogers BH, Silvis SE, Nebel OT et al (1973) Complications of flexible fiberoptic colonoscopy and polypectomy. Gastrointest Endosc 22:73–77

    Google Scholar 

  27. Farley DR, Bannon MP, Zietlow SP et al (1997) Management of colonoscopic perforations. Mayo Clinic Proc 72:729–733

    Article  CAS  Google Scholar 

  28. Avgerinos DV, Llaguna OH, Lo AY et al (2008) Evolving management of colonoscopic perforations. J Gastrointest Surg 12:1783–1789

    Article  PubMed  Google Scholar 

  29. Bleier JI, Moon V, Feingold D et al (2008) Initial repair of iatrogenic colon perforation using laparoscopic methods. Surg Endosc 22:646–649

    Article  CAS  PubMed  Google Scholar 

  30. Garcia E, Lopez Kostner F, Rollan A et al (2008) Diagnóstico y tratamiento de la perforación colónica durante la colonoscopía. Rev Med Chile 136:310–316

    PubMed  Google Scholar 

  31. Rumstadt B, Schilling D, Sturm J (2008) The role of laparoscopy in the treatment of complications after colonoscopy. Surg Laparosc Endosc Percutan Tech 18:561–564

    Article  PubMed  Google Scholar 

  32. Teoh AYB, Poon CH, Lee JFY et al (2009) Outcomes and predictors of mortality and stoma formation in surgical management of colonoscopic perforations. Arch Surg 144:9–13

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Colorectal Surgery Section, General Surgery Department, Hospital Alemán de Buenos Aires, Av Pueyrredón 1640 (1118), Buenos Aires, Argentina

    Nicolas A. Rotholtz, Mariano Laporte, Sandra Lencinas, Maximiliano Bun, Alejandro Canelas & Norberto Mezzadri

Authors
  1. Nicolas A. Rotholtz
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  2. Mariano Laporte
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  3. Sandra Lencinas
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  4. Maximiliano Bun
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  5. Alejandro Canelas
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  6. Norberto Mezzadri
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Corresponding author

Correspondence to Nicolas A. Rotholtz.

Additional information

Accepted for oral presentation at the meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Scientific Sessions, 9–12 April 2008, Philadelphia, PA.

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Rotholtz, N.A., Laporte, M., Lencinas, S. et al. Laparoscopic Approach to Colonic Perforation due to Colonoscopy. World J Surg 34, 1949–1953 (2010). https://doi.org/10.1007/s00268-010-0545-x

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  • DOI: https://doi.org/10.1007/s00268-010-0545-x

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