title: Colonoscopic perforation management by laparoendoscopy: an algorithm.
abstract: OBJECTIVE
  The role of laparoscopy in the management of iatrogenic colonoscopic injuries has increased with surgeons becoming facile with minimally invasive methods. However, with a limited number of reported cases of successful laparoscopic repair, the exact role of this modality is still being defined. Drawing from previous literature and our own experiences, we have formulated a simple algorithm that has helped us treat colonoscopic perforations.
  
  
  METHODS
  A retrospective review was undertaken of patients treated for colonoscopic perforations since the algorithm's introduction. For each patient, initial clinical assessment, management, and postoperative recovery were carefully documented. A Medline search was performed, incorporating the following search words: colonoscopy, perforation, and laparoscopy. Twenty-three articles involving 106 patients were identified and reviewed.
  
  
  RESULTS
  Between May 2009 and August 2012, 7 consecutive patients with colonoscopic perforations were managed by 2 surgeons using the algorithm. There were no complications and no deaths, with a mean length of stay of 4.43 days (range, 2-7 days). Of the 7 patients, 6 required surgery. A single patient was managed conservatively and later underwent an elective colon resection.
  
  
  CONCLUSIONS
  Traditionally, laparotomy was the preferred method for treating colonoscopic perforations. Our initial experience reinforces previous views that laparoendoscopic surgery is a safe and effective alternative to traditional surgery for managing this complication. We have formulated a simple algorithm that we have found helpful for surgeons considering a laparoscopic approach to managing this condition.
authors.affiliation: Department of Surgery, Providence Hospital and Medical Centers, 16001 W Nine Mile Rd, Southfield, MI, USA. taffyowm@yahoo.com.
authors.forename: Tafadzwa Patrick
authors.initials: TP
authors.lastname: Makarawo
authors.affiliation: Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI, USA.
authors.forename: Amir
authors.initials: A
authors.lastname: Damadi
authors.affiliation: Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI, USA.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Mittal
authors.affiliation: Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI, USA.
authors.forename: Ed
authors.initials: E
authors.lastname: Itawi
authors.affiliation: Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI, USA.
authors.forename: Gurteshwar
authors.initials: G
authors.lastname: Rana
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003082:Colectomy / Q000379:methods*; D003106:Colon / Q000293:injuries* / Q000601:surgery; D003108:Colonic Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects*; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome