Untitled

Abstract

Laparoscopic surgery recently has been conducted to repair colonic perforation that is associated with colonoscopy. The authors describe their laparoscopic repair of perforation using passing sutures and an endoscopic linear stapler. One 12-mm and several 5-mm trocars were inserted in the lower abdomen under general anesthesia. Observing with a laparoscope, passing sutures were threaded transversely through all layers of the margin of defect and pulled up with forceps to hold the margin straight, along which the defect was stapled with an endoscopic linear stapler. The authors applied this method for five patients, where the perforation occurred in the sigmoid colon or in the cecum (perforation size ranging from 10 mm to 50 mm). Perforation was successfully repaired in all patients, with no complications because of perforation or the procedures. The current method is beneficial because the perforated lesion is safely and easily closed and postoperative colonic stenosis is avoided.

Laparoscopic repair using an endoscopic linear stapler for management of iatrogenic colonic perforation during screening colonoscopy.

“…Our operation time was similar to that reported previously for laparoscopic repair using an endoscopic linear stapler for colonoscopic perforation [15]. A couple of reports using laparoscopic direct suture showed a longer operation time [16, 18].…”

“…In our study, only one larger defect (30 mm) needed two passing sutures without knot-tying to lift up into balance the margin of the perforation. Lifting of the perforated colonic margin using passing sutures is effective because stapling could cover all layers and the limited resection would lessen the possibility of postoperative colonic stenosis, even in cases of larger defects [10, 15].…”

“…Laparoscopic direct suture can be performed for the management of small perforations without extensive tissue injury, but some larger or extensive cases may need a tangential resection or segmental resection [14]. A couple of reports on the primary repair of colonoscopic perforations have described the performance of a tangential resection using an endoscopic linear stapler [10, 11, 14, 15].…”

“…Laparoscopic repair using an endoscopic linear stapler may be safe, easy, and rapid, even in cases of larger injuries, since this method does not require the use of laparoscopic suturing and knot-tying techniques. However, several concerns keep this endoscopic linear stapler repair technique from being widely used, including the following: (1) the margin of the perforation could be injured by the laparoscopic instrument; (2) larger tangential resection might lead to postoperative colonic stenosis; and (3) the endoscopic linear stapler should be applied only in a transverse manner along the running direction of the colon to avoid postoperative colonic stenosis and, thus, cannot necessarily be used in all instances of colonoscopic perforation [15].…”