Ann Surg Treat Res.  2014 Sep;87(3):139-143. 10.4174/astr.2014.87.3.139.

Comparison of the surgical outcomes of laparoscopic versus open surgery for colon perforation during colonoscopy

• Kim J
• Lee GJ
• Baek JH
• Lee WS

• KMID: 1908484
• DOI: http://doi.org/10.4174/astr.2014.87.3.139

Abstract

PURPOSE
Colonoscopy is a safe and commonly used method for the screening of colon cancer, but sometimes major complications, such as, colonic perforation or hemorrhage occur during the procedure. The aim of this study was to compare the surgical outcomes of laparoscopic and open surgery for colon perforation after colonoscopy.
METHODS
A retrospective review of patient records was performed on 25 patients with iatrogenic colon perforation during colonoscopy during the 7-year period from January 2005 to June 2012. Demographic data, operative procedures, operation times, postoperative complications, hospital course, and morbidities in the laparoscopic surgery group (LG) and open surgery group (OG) were compared.
RESULTS
Seventeen of the 25 patients underwent laparoscopic surgery (68%) and 8 patients open surgery (32%). The most common surgical methods were primary repair in the LG, and Hartmann's operation in the OG. Average time to first flatus was 2.9 days in the LG and 4.5 days in the OG, and average times to first meals were 4.5 days and 5 days, respectively. Mean hospital stays were 10.8 days in the LG and 17 days in the OG. After surgery, complications occurred in two patients in the LG, but no complication occurred in the OG.
CONCLUSION
Laparoscopic repair for iatrogenic colonic perforation during colonoscopy seems to be useful and safe surgical method in early period after perforation. However, open surgery is also needed for the delayed cases after perforation.

Keyword

Laparoscopy; Intestinal perforation; Colonoscopy

MeSH Terms

Colon*
Colonic Neoplasms
Colonoscopy*
Flatulence
Hemorrhage
Humans
Intestinal Perforation
Laparoscopy
Length of Stay
Mass Screening
Meals
Postoperative Complications
Retrospective Studies
Surgical Procedures, Operative

Reference

1. Wullstein C, Koppen M, Gross E. Laparoscopic treatment of colonic perforations related to colonoscopy. Surg Endosc. 1999; 13:484–487.

2. Luning TH, Keemers-Gels ME, Barendregt WB, Tan AC, Rosman C. Colonoscopic perforations: a review of 30,366 patients. Surg Endosc. 2007; 21:994–997.

3. Carpio G, Albu E, Gumbs MA, Gerst PH. Management of colonic perforation after colonoscopy. Report of three cases. Dis Colon Rectum. 1989; 32:624–626.

4. Bleier JI, Moon V, Feingold D, Whelan RL, Arnell T, Sonoda T, et al. Initial repair of iatrogenic colon perforation using laparoscopic methods. Surg Endosc. 2008; 22:646–649.

5. Miranda L, Settembre A, Piccolboni D, Capasso P, Corcione F. Iatrogenic colonic perforation: repair using laparoscopic technique. Surg Laparosc Endosc Percutan Tech. 2011; 21:170–174.

6. Park HR, Baek SK, Bae OS, Park SD. Treatment of colon perforation associated with colonoscopy. J Korean Soc Coloproctol. 2008; 24:322–328.

7. Lee SH, Choi GS, Lee JH. Laparoscopic treatment of colonic injury caused by colonoscopy. J Korean Soc Coloproctol. 2004; 20:257–262.

8. Coimbra C, Bouffioux L, Kohnen L, Deroover A, Dresse D, Denoel A, et al. Laparoscopic repair of colonoscopic perforation: a new standard? Surg Endosc. 2011; 25:1514–1517.

9. Rho SY, Bae SU, Baek SJ, Hur H, Min BS, Baik SH, et al. Feasibility and safety of laparoscopic resection following stent insertion for obstructing left-sided colon cancer. J Korean Surg Soc. 2013; 85:290–295.

10. Lohsiriwat V. Colonoscopic perforation: incidence, risk factors, management and outcome. World J Gastroenterol. 2010; 16:425–430.

11. Rotholtz NA, Laporte M, Lencinas S, Bun M, Canelas A, Mezzadri N. Laparoscopic approach to colonic perforation due to colonoscopy. World J Surg. 2010; 34:1949–1953.

12. Gedebou TM, Wong RA, Rappaport WD, Jaffe P, Kahsai D, Hunter GC. Clinical presentation and management of iatrogenic colon perforations. Am J Surg. 1996; 172:454–457.

13. García Martínez MT, Ruano Poblador A, Galán Raposo L, Gay Fernández AM, Casal Nunez JE. Perforation after colonoscopy: our 16-year experience. Rev Esp Enferm Dig. 2007; 99:588–592.

14. Oh JE, Shim SG. Colonoscopic perforation; a 10-year experience in single general hospital. Korean J Gastroenterol. 2009; 54:371–376.

15. Iqbal CW, Chun YS, Farley DR. Colonoscopic perforations: a retrospective review. J Gastrointest Surg. 2005; 9:1229–1235.

16. Araghizadeh FY, Timmcke AE, Opelka FG, Hicks TC, Beck DE. Colonoscopic perforations. Dis Colon Rectum. 2001; 44:713–716.

17. Hall C, Dorricott NJ, Donovan IA, Neoptolemos JP. Colon perforation during colonoscopy: surgical versus conservative management. Br J Surg. 1991; 78:542–544.

18. Park HC, Kim DW, Kim SG, Park KJ, Park JG. Surgical management of colonoscopic perforations. J Korean Soc Coloproctol. 2007; 23:287–291.

19. Hansen AJ, Tessier DJ, Anderson ML, Schlinkert RT. Laparoscopic repair of colonoscopic perforations: indications and guidelines. J Gastrointest Surg. 2007; 11:655–659.

20. Cho SB, Lee WS, Joo YE, Kim HR, Park SW, Park CH, et al. Therapeutic options for iatrogenic colon perforation: feasibility of endoscopic clip closure and predictors of the need for early surgery. Surg Endosc. 2012; 26:473–479.