Laparoscopic Primary Repair of Iatrogenic Colon Perforation

Abstract

Purpose. Iatrogenic colon perforation is a rare but serious complication of colonoscopy. Surgical intervention is frequently performed using traditional exploratory laparotomy for repair or colectomy; however, the laparoscopic approach may be an alternative option. We report our experience with laparoscopic suture repair and evaluate its effects compared with open surgery. Methods. We retrospectively analyzed data for eighteen patients who underwent surgical repair after colonoscopy-induced iatrogenic colon perforation between December 2003 and November 2008. Fourteen patients received traditional exploratory laparotomies with primary repair or colectomy. Four patients underwent diagnostic laparoscopy and direct laparoscopic suture repair. The estimated perforation duration, operative time, and length of hospitalization were compared. Results. In the open surgery group, four patients underwent primary repair of the defect, one of whom added loop T-colostomy for fecal diversion. The others received colectomies, and fecal diversion with loop ileostomy was performed in two. In the laparoscopic group, four patients underwent laparoscopic primary intra-corporeal suture repair. Blood loss was statistically less significant during the laparoscopic approach and the operative times were not different. Although a higher wound infection rate along with more prolonged post-operative ileus and longer hospital stays were noted in the open method, the difference was not statistically significant due to the limited number of cases. Conclusion. An initial laparoscopic approach for diagnosis of iatrogenic perforations followed by laparoscopic colorraphy of the colon seems safe and efficacious when compared to open surgery. It is reasonable to consider laparoscopic repair of iatrogenic colon perforation as an alternative option.