PURPOSE: Colonoscopy is a reliable and useful tool for diagnosis, surveillance and treatment of colorectal disease. In spite of its safety, in a large number of procedures, serious complications such as perforation or bleeding of the colon are rare, but inevitable. Laparoscopically, we treated patients with complications after diagnostic or therapeutic colonoscopy and evaluated the safety and the usefulness of laparoscopic treatment. METHODS: From December 2002 to November 2003, thirteen patients were referred to us from regional colonoscopic clinics for laparoscopic surgery due to complications of colonoscopy. All patients presented radiologic intra- or retro-peritoneal free air and various degrees of clinical symptoms or signs comparable to colonic injury, such as abdominal pain and tenderness, distension, and/or fever. One patient with mild symptoms and an other colonoscopically treated were excluded for this study. Patients were followed up at least for two months after the operation. RESULTS: Laparoscopic procedures ranged from exploration only or closure of a perforated colon to a standard operation for colorectal cancer according to the degree of injury or associated disease. The mean operative time was 102 min. Patients resumed meals at the 2nd to 4th post-operative day and were discharged 5 to 8 days after the operation. No operative complications occurred. CONCLUSIONS: Laparoscopic surgery for complications of colonoscopy is feasible and safe and can allow an unnecessary laparotomy to be avoided. Even in patients with colonic injury due to the colonoscope and colorectal cancer together, laparoscopic surgery can be an alternative method for treatment of the disease.