Transabdominal transcolonic polypectomy.
Up until now, 2%-10% of colonic polyps larger than 2 cm have been considered colonoscopically unresectable. These were commonly treated by piecemeal resection and observation by colonoscopists and hemicolectomy by surgeons. Our minimally invasive "rural solution" in this situation is transcolonic resection through a mini-laparotomy. We present 7 patients with large colonic villous adenomas not amenable to colonoscopic resection. Laporoscopy determined the location of the muscle-splitting incision. The segment of bowel containing the polyp was exteriorized: antimesentric polyps were excised together with the corresponding colonic wall; polyps in mesenteric location were removed transmurally through an anterior colotomy. There was no surgical morbidity. Five of the 7 patients were discharged within 24 hours. Preoperative tattooing of the lesions and laparoscopic mobilization of the involved segment--when necessary--proved to be useful adjuncts. This seems to be an attractive option that may be superior to formal colectomy or repeated endoscopic piecemeal excision of large polyps. It provides colonoscopists with the option of avoiding having to resect very difficult polyps while not subjecting their patients to unnecessarily morbid operations.
Schmitt
Edward Alexander
EA
455 E Pikes Pk, Suite 101, Colorado Springs, CO 80904, USA. schmittcow@aol.com
D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000601:surgery*; D003111:Colonic Polyps / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures