Laparoscopic treatment of colonic perforations related to colonoscopy

Wullstein, Ch.; Köppen, M.-O.; Gross, E.

doi:10.1007/s004649901018

Cited by 81 publications

(63 citation statements)

References 15 publications

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“…Regarding technique, endoscopic sub-mucosal dissection (ESD) is known to carry a higher perforation risk than endoscopic mucosal resection (EMR) or polypectomy (5,6). The rate of hemorrhage has been reported to be 1% to 2% and is more visible after polypectomy and dilatation of structures compared to other procedures (7)(8)(9). Perforation may occur from direct mechanic effects (sharp edge) of the colonoscope, barotrauma, or thermal burns during polypectomy (5).…”

Section: Discussionmentioning

confidence: 99%

Colonoscopic perforations: Single center experience and review of the literature

Çolak¹,

Gürbulak²,

Bektaş³

et al. 2017

Turk J Surg

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Colonoscopic perforations: Single center experience and review of the literature INTRODUCTION Colonoscopy is accepted as the gold standard imaging modality for the diagnosis of colon and distal ileum diseases. It aids the detection of smaller lesions and tissue sampling and also functions as a therapeutic procedure for intestinal diseases. Similar to other invasive procedures, colonoscopy has been associated with various complications; among these, perforation is the most important. Iatrogenic colonic perforation has high rates of mortality and morbidity. It is mainly divided into two categories: diagnostic and therapeutic (1, 2). Management includes both medical and surgical approaches. However, the best approach for treatment depends on various factors, such as the patient's general condition, age, comorbidities, and, most importantly, the time between the onset and diagnosis of perforation. In this study, we aimed to evaluate the incidence of perforation in a large colonoscopy series, discuss patient management strategies, and analyze the clinical consequences of iatrogenic colonic perforation. MATERIAL AND METHODSBetween January 2005 and May 2015, a total of 31,655 lower GIS endoscopies were performed at our center. Patients with iatrogenic colonic perforations were investigated retrospectively. All procedures were conducted under sedoanalgesia. The procedures were performed by 27 endoscopists, including 24 general surgeons and 3 gastroenterology specialists. The experience of the endoscopists varied between 2 and 15 years.We analyzed the demographic characteristics of the patients, the type of procedure (therapeutic or diagnostic), indications for colonoscopy and associated colonic disease, location and detection time of perforation, management strategy (operative or nonoperative), and complications.The perforations were detected either during colonoscopy by observing a visible defect in the colonic wall (mesenteric or antimesenteric side) or after the procedure by detecting free intra-abdominal air upon radiological examination. Patients who complained of abdominal pain or distention following 195Objective: Iatrogenic colonic perforation is a well-known complication that can increase mortality and morbidity in patients undergoing colonoscopy. Closer follow-up and a well-planned treatment strategy are required when perforation arises as a complication. The aims of this study are to (1) report our experience with a large colonoscopy series; (2) evaluate the underlying mechanisms of iatrogenic colonic perforation; (3) discuss the ideal period between onset and treatment; and (4) review the current literature regarding the management of iatrogenic colonic perforations. Material and Methods:Patients who underwent colonoscopy between January 2005 and May 2015 at a single center were reviewed retrospectively. Procedures during which colonic perforations occurred were documented and analyzed.Results: Between January 2005 and May 2015, 31,655 patients underwent colonoscopy and 5,214 patients underwent recto-sigmoi...

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Section: Discussionmentioning

confidence: 99%

Colonoscopic perforations: Single center experience and review of the literature

Çolak¹,

Gürbulak²,

Bektaş³

et al. 2017

Turk J Surg

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“…[8][9][10][11][12][13]. Hingegen ist die konservative Therapie nur in ausgewählten Fällen unter engmaschiger klinischer Kontrolle und bei klinisch eindeutiger Besserungstendenz gerechtfertigt [6,[14][15][16].…”

Section: Materials Und Methodikunclassified

Iatrogene Kolonperforation

et al. 2004

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ZusammenfassungHintergrund: Die iatrogene Kolonperforation ist eine seltene, jedoch gefürchtete Komplikation der Koloskopie. Eine konservative Therapie ist zwar in ausgewähl-ten Fällen vertretbar, führt jedoch bei Versagen häufig zu operativen Eingriffen mit höherer Morbidität und Letalität im Vergleich zu einer sofortigen und definitiven chirurgischen Versorgung. Die laparoskopische Chirurgie bietet hier eine Alternative zur konventionellen Operation.Material und Methodik: Die Daten aller Patienten, die innerhalb eines 7-Jahres- Zeitraums (1997Zeitraums ( -2003 wegen einer iatrogenen Kolonperforation laparoskopisch operiert wurden, wurden im Rahmen der prospektiven Datenbank "Laparoskopische kolorektale Chirurgie" erfasst und retrospektiv hinsichtlich Alter, Geschlecht, Perforationslokalisation, Diagnostik und Klinik, Operationsverfahren, intra-und postoperativer Komplikationen sowie des postoperativen Verlaufs analysiert.Ergebnisse: Im Beobachtungszeitraum wurden sechs Patienten mit einer iatrogenen Kolonperforation laparoskopisch operiert. Dabei lag die Perforation bei fünf Patienten im linken und bei einem Patienten im rechten Kolon. Die Ursache für die Perforation war in drei Fällen eine therapeutische Koloskopie, in zwei Fällen eine diagnostische Koloskopie sowie in einem Fall die Anlage eines suprapubischen Blasenkatheters. Alle Patienten wurden noch am Aufnahmetag diagnostisch laparoskopiert und minimalinvasiv versorgt. Dabei erfolgte bei fünf Patienten mit Kolonpathologien (Divertikulitis, Polyp) eine Resektion des betroffenen Darmabschnitts, während bei einem Patienten eine Übernähung der Perforation durchgeführt wurde. Im postoperativen Verlauf traten keine Wundinfekte oder andere chirurgische Komplikationen auf. Schlussfolgerung: Die laparoskopische Therapie von iatrogenen Verletzungen desKolons ist effizient und sicher durchführbar. Somit bietet sie in der Hand des erfahrenen Chirurgen eine Bereicherung der therapeutischen Möglichkeiten bei der iatrogenen Kolonperforation. AbstractBackground: Iatrogenic colon perforation is a rare but life-threatening complication of colonoscopy. Although conservative therapy is possible in selected cases, it often leads to the necessity of more extensive operations with increased morbidity as opposed to immediate and definite surgery in case of failure. Laparoscopic colorectal surgery offers a reasonable alternative to conventional laparotomy.

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“…Para aquellos pacientes con contaminación peritoneal mayor, cuadro séptico en evolución y malas condiciones generales, el aseo peritoneal y la operación de Hartmann sería lo indicado 18 . El abordaje laparoscópico también resulta interesante con buenos resultados en pacientes seleccionados, reduciendo la morbilidad asociada a la laparotomía, con los consabidos beneficios de la cirugía mínimamente invasiva 19,20 .…”

Section: N V E S T I G a C I ó Nunclassified