Laparoscopic Monitored Colonoscopic Polypectomy vs Laparoscopic Right Hemicolectomy: A Comparative Analysis on 187 Patients with Polys in the Right Colon

Morris E Franklin Jr, MD, FACS, Song Liang, MD, PhD, Jeffrey L Glass, MD, FACS

Texas Endosurgery Institute

Background: This prospective comparison study focused on the patients with colonoscopic nonresectable polyps in right colon who underwent either laparoscopic right hemicolectomy (LRH) or laparoscopic monitored colonoscopic polypectomy (LMCP) and was specifically aimed at investigating if LMCP can be accepted as a simple and effective approach for removing difficult polyps due to loss of visibility on the polyp’s base, non-accessible locality of polyp, tortuosity of the right colon.

Method: A prospectively designed database of a consecutive series of patients with either LRH or LMCP for benign polyps in right colon from 1991 to 2012 at Texas Endosurgery Institute was analyzed, and all the statistical calculations was performed with on-line MedCalc.

Results: A total 119 patients had LMCP for removing the polyps in the right colon while 77 patients were operated with RHC to manage the benign polyps. In comparison, LCMP showed significant difference from LRH arm on operative time (125.4 +/- 22.3 minutes vs. 144.6 +/- 23.3 minutes p=0.0006), estimated blood loss (34.9+/- 22.7 ml vs. 114.7 +/- 44.5 ml, p<0.0001), hospital stay (8.6+/-6.3 days vs. 1.85+/-1.09 days, p<0.0001). However no difference was found on the size of removed polyps (2.4+/-1.0 cm vs. 2.8+/-0.7, p=0.16) and intraoperative as well as postoperative complication rates. Moreover 7 patients (5.8%) with LMCP were converted to LRH for the intraoperative pathology of adenocarcinoma, and 5 patients (4.25%) with LMCP also were further managed with partial cecacetomy or primary repair due to colonic wall damage from colonoscopic polypectomy. Lastly all the patients with LMCP had been followed from 6 to 196 months to find no recurrence.

Conclusions: This comparison study demonstrated that LMCP is not only safe and effective approach also causes less surgical damage to the patients with significantly decrease operative time and days of hospital stay, thus it can be promoted to be a alternative approach to remove colonoscopic nonresectable polyps in right colon.

Session: Podium Presentation

Program Number: S036

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