Introduction: Iatrogenic colonic perforation during colonoscopy is a rare but potentially lethal complication. It can occur during diagnostic and therapeutic endoscopy and can be related to various mechanisms. The management of such perforations is usually surgical but there is debate as to the appropriate approach. We present our experience with laparoscopic colorraphy without resection or diversion for such injuries.
Methods and Procedures: Two patients were referred to us within hours after a colonoscopic perforation had occurred. One was an 83 year-old female and the other a 64 year-old male. Both perforations occurred in the sigmoid colon during screening colonoscopies and were visualized and immediately diagnosed by the endoscopist at the time of the procedure. Both patients had significant abdominal pain and distension. Both patients were taken to the operating room within 6 hours of the perforation and a laparoscopic exploration was performed. Four 5-mm trocars were used. The perforations were easily identified and consisted of a 1 cm perforation at the recto-sigmoid junction and a 2 cm perforation in the mid sigmoid colon respectively, with no fecal contamination. The perforations were repaired in two layers using a running 3-0 polyglactin 910 full-thickness suture for the inner layer followed by an interrupted 3-0 silk seromuscular layer. The peritoneal cavity was washed out in all quadrants and no drains were used. Operative times were 60 minutes. Both patients did well postoperatively and were discharged in 3 days tolerating a regular diet and having normal bowel function.
Conclusions: Laparoscopic colorraphy is a safe minimally invasive approach for managing colonoscopic perforations in the absence of extensive inflammation or fecal spillage and when no residual pathology is present. In experienced hands, it allows avoiding an unnecessary laparotomy while providing all the benefits of minimally invasive surgery. Laparoscopic colorraphy should be considered in the selective management of colonoscopic perforations.
Program Number: P159