Efficacy of Laparoscopic Primary Repair in the Treatment of Colonic Perforation After Colonoscopy: A Review of 40,127 Patients

Zhong, Wu; Qiu, Chongrong; Liu, Chuanyuan; Fang, Chuanfa; Xia, Laiyang; Liang, Junlin; Zhang, Seng; Chen, Lisheng

doi:10.1097/sle.0000000000000360

Cited by 13 publications

(27 citation statements)

References 20 publications

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“…Therefore, regions with acute angles and redundancy are the most frequent sites of colonoscopic perforation. As in our study, the most common perforation sites during colonoscopy are typically the sigmoid and rectosigmoid colon [17, 18, 20]. Of course, the redundant sigmoid colon would be the most suitable site for laparoscopic application of an endoscopic linear stapler.…”

Section: Discussionmentioning

confidence: 73%

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

Kim

Jung

et al. 2018

Videosurgery and Other Miniinvasive Techniques

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Introduction Colonoscopy is a safe and effective procedure, but it is also an inevitably invasive one. Laparoscopic repair of colonoscopic perforations has been reported to be a safe and effective treatment. Aim We present our surgical technique and outcomes of laparoscopic repairs using an endoscopic linear stapler for iatrogenic colonic perforation during screening colonoscopy. Material and methods Laparoscopic repair using an endoscopic linear stapler for iatrogenic colonic perforation during screening colonoscopy was performed by two experienced laparoscopic surgeons on 14 consecutive patients between April 2010 and December 2017 at our hospital. Using prospectively collected data, an observational study was performed on a per protocol basis. Results The mean age of the 14 patients who underwent laparoscopic repair was 56.6 ±9.1 years. The most common perforation site was the sigmoid colon in 10 (71.4%) patients, followed by the rectosigmoid junction in 3 (21.4%) patients and the splenic flexure in 1 (7.1%) patient. The median perforation size was 10 (range: 5–30) mm. The mean operation time was 73.9 ±28.2 min. Postoperative complications occurred in 1 (7.1%) patient. There was no postoperative mortality or reoperation within 30 days after surgery. The median time to tolerance of a regular diet was 5 (range: 3–6) days. The median postoperative hospital stay was 8.5 (range: 5–15) days. Conclusions Laparoscopic repair using an endoscopic linear stapler is a safe, easy, and effective surgical technique to treat colonic perforation related to screening colonoscopy.

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Section: Discussionmentioning

confidence: 73%

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

Kim

Jung

et al. 2018

Videosurgery and Other Miniinvasive Techniques

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“…Of these, 12 articles were excluded for the following reasons: no control group (n = 7); inadequate design (n = 2); no usable data (n = 2); mixed disease (n = 1). Ultimately, 11 articles [12,13,[18][19][20][21][22][23][24][25][26] (America = 2, Argentina = 1, Belgium = 1, Germany = 2, Korea = 3, China = 2) totaling 323 patients were finally eligible for the quality assessment,of whom 192 underwent LS and 131 underwent OS. A flowchart of the literature search and selection is illustrated in (Fig.…”

Section: Selected Studiesmentioning

confidence: 99%

“…Ten studies [12,13,[18][19][20][22][23][24][25][26] were included (LS = 182, OS = 128), and low heterogeneity among the studies (I 2 = 0%, P = .63). In the pooled data, there was no significant difference in sex ratio between the groups (OR = 1.35; 95% CI: 0.85 to 2.16; P = .20; Fig.…”

Section: Sex Ratiomentioning

confidence: 99%

Laparoscopic versus open surgery for colonoscopic perforation: A systematic review and meta-analysis

et al. 2023

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Background: The efficacy of laparoscopic surgery (LS) for the treatment of colonoscopic perforation is still controversial. The purpose of this meta-analysis was to evaluate the effectiveness and safety of LS versus open surgery (OS) for colonoscopic perforation.Methods: All clinical trials that compared laparoscopic with OS for colonoscopic perforation published in English were identified in PubMed, EMBASE, Web of Science, and Cochrane Library searches. A modified scale was used to assess the quality of the literature. We analyzed the age, sex ratio, aim of colonoscopy, history of abdominopelvic surgery, type of procedure, size of perforation, operation time, postoperative fasting time, hospital stay, postoperative complication morbidity, and postoperative mortality. Meta-analyses were performed using weighted mean differences for continuous variables, and odds ratios for dichotomous variables.Results: No eligible randomized trials were identified, but eleven nonrandomized trials were analyzed. In the pooled data of 192 patients who underwent LS and 131 OS, there were no significant differences in age, sex ratio, aim of colonoscopy, history of abdominopelvic surgery, perforation size, and operative time between the groups. LS group had shorter time of hospital stay and postoperative fasting time, less postoperative complication morbidity, but there were no significant difference in postoperative mortality rate between LS group and OS group.Conclusions: Based on the current meta-analysis, we conclude that LS is a safe and efficacious technique for colonoscopic perforation, with fewer postoperative complications, less hospital mortality, and faster recovery compared with OS.

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“…The reasons may include the advantages of less trauma, less postoperative morbidity, less pain and shorter hospitalization 5. In recent years, some studies have reported that laparoscopic surgery is safe and effective in the treatment of colonic perforation 6. However, there has been no systemic report on the application of laparoscopy in SCP.…”

mentioning

confidence: 99%

Laparoscopic Management of Spontaneous Colonic Perforation: A Single Institution Study of 52 Patients

Zheng

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Spontaneous colonic perforation (SCP) is associated with an devastating result. The use of laparoscopy for SCP remains controversial. This study aimed to compare the postoperative outcomes of patients who received either laparoscopic or open surgery and to evaluate the efficacy of laparoscopic surgery and the risk factors affecting prognosis. Patients and Methods: A retrospective study of patients who underwent surgery for SCP from January 2005 to December 2020 was performed. Demographic data, intraoperative variables, length of stay, and surgical complications were retrieved. Results: A total of 52 patients were postoperatively diagnosed with SCP. Thirty (57.69%) procedures were performed using laparoscopic surgery (group A) and 22 (42.31%) were performed using open surgery (group B). There were no significant differences between groups A and B in terms of age, sex, chronic concomitant disease, chronic constipation, incentives, imaging findings, preoperative diagnosis, American Society of Anesthesiologists (ASA) score, Mannheim Peritonitis Index (MPI), operation time, days to resumption of liquids, site of perforation, surgical procedures, or types of perforation (P>0.05). The incidence of wound infection in group A was significantly lower than that in group B (P<0.05), but there was no significant difference in the incidence of abdominal abscess between the 2 groups (P>0.05). Significant differences were found in days to start walking and days to resumption of solids between the 2 groups (P<0.05). Group B had a longer length of hospital stay than group A (P<0.05). After multivariate analysis, the independent variables associated with worse perioperative complications were an age of 65 years and older, an ASA score of ≥3, and an MPI of >26. Conclusions: The prognosis of SCP is poor. The operation should follow principles that are simple, rapid, and effective. If there are no contraindications, laparoscopy may be the preferred method. Hartmann procedure is a promising surgical strategy. The age, ASA score, and MPI may indicate the severity and prognosis of SCP.

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Efficacy of Laparoscopic Primary Repair in the Treatment of Colonic Perforation After Colonoscopy: A Review of 40,127 Patients

Abstract: Laparoscopic primary repair is safe and effective in resolving colonic perforation due to colonoscopy, and it might offer benefits over the open approach.

Cited by 13 publications

References 20 publications

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

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

Laparoscopic versus open surgery for colonoscopic perforation: A systematic review and meta-analysis

Laparoscopic Management of Spontaneous Colonic Perforation: A Single Institution Study of 52 Patients

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