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Laparoscopic management of colonoscopic perforations

Authors
Publication Date
Keywords
  • Colon
  • Colon Resection
  • Laparoscopy
  • Peritonitis
  • Management
  • Complication
  • Human Health Sciences :: Gastroenterology & Hepatology [D08]
  • Sciences De La Santé Humaine :: Gastroentérologie & Hépatologie [D08]
  • Human Health Sciences :: Surgery [D26]
  • Sciences De La Santé Humaine :: Chirurgie [D26]
Disciplines
  • Medicine

Abstract

AbstractsA-D - D70 - LAPAROSCOPIC MANAGEMENT OF COLONOSCOPIC PERFORATIONS. L. Bouffioux (1), C. Coimbra (1), A.C. Lespagnard (1), D. Dresse (2), O. Detry (1), A. De Roover (1), P. Honore (1), J. Belaiche (1), A. Denoel (2), J. Deflandre (2). (1) ULg Sart Tilman ; (2) CHR CITADELLE, Liège. Background : The gold standard surgical treatment of colonoscopy perforations remains laparotomy with or without ostomy. Laparoscopic management is a recent approach, only described in small series. Objective : We hypothesised that laparoscopic treatment of iatrogenic colon perforation would result in equal therapeutic efficacy, less morbidity, decreased length of stay, and overall better short-term outcome compared to open methods. Methods : We retrospectively reviewed the records of patients with iatrogenic colonoscopic perforations between 1980 and 2008 in two different centers. The patients’ demographic data, perforation location, therapy and outcome were recorded. Results : A total of 43 iatrogenic perforations were identified in 22 men and 21 women (median age : 66.5 y). All but one were managed operatively (19 laparoscopy, 23 laparotomy). The sigmoid colon was the most frequent site of per- foration (65.1%). Patients underwent primary repair (52.4%), resection with primary anastomosis (26.2%), or fecal diversion (21.4%). Patients diagnosed within 24 hours (76,2%) were more likely to have minimal peritoneal contami- nation (30 patients vs 2 ; P = 0.01) and to undergo a laparoscopic approach with primary repair or resection with anastomosis. Patients diagnosed after 24 hours (23,8%) were more likely to have fecal contamination or purulent peri- tonitis (8 patients vs 3 ; P = 0.01) and to undergo ostomy by laparotomy. Global morbidity and mortality were 31% and 7.1%, respectively. Three of the laparoscopic procedures had to be converted in laparotomy because of the length of the injury (1 case) and the fragility of the tissues (2 cases). Overall patients who underwent laparoscopic repair had short- e

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