Laparoscopic approach to colonic perforation due to colonoscopy.
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.
Rotholtz
Nicolas A
NA
Colorectal Surgery Section, General Surgery Department, Hospital Alemán de Buenos Aires, Av Pueyrredón 1640 (1118), Buenos Aires, Argentina. nrotholtz@hospitalaleman.com
Laporte
Mariano
M
Lencinas
Sandra
S
Bun
Maximiliano
M
Canelas
Alejandro
A
Mezzadri
Norberto
N
D016009:Chi-Square Distribution; D003082:Colectomy; D003113:Colonoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007416:Intestinal Perforation / Q000209:etiology* / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome