Initial repair of iatrogenic colon perforation using laparoscopic methods

Background: Iatrogenic perforation of the colon during elective colonoscopy is a rare but serious complication. Treatment using laparoscopic methods is a novel approach, only described in the recent literature. We hypothesized that laparoscopic treatment of iatrogenic colon perforation would result in equal therapeutic efficacy, less perioperative morbidity, smaller incisions and decreased length of stay, and an overall better short-term outcome compared to open methods. Methods: We reviewed our prospectively collected patient database from July 2001 to July 2005 and compared the intraoperative data and postoperative outcomes of patients who underwent laparoscopic primary repair versus those who had open primary repairs of iatrogenically perforated large bowel. Results: The laparoscopic (mean age 70 years; range 20-91 years; 18 percent male) and open (mean age 68 years; range 36-87 years; 43 percent male) groups were similar with regard to age. Overall, patients who underwent laparoscopic (n = 11) versus open (n = 7) repair had comparable operative (OR) times (mean 104 minutes, range 60-150 minutes versus mean 98 minutes, range 40-130 minutes, p = 0.04), shorter length of stay [LOS, (5.1 ± 1.7 days versus 9.2 ± 3.1 days, p = 0.01)], fewer complications (two versus five, p = 0.02) and shorter incision length (16 ± 14.7 mm versus 163 ± 54.4 mm, p = 0.001). Conclusions: A laparoscopic approach to iatrogenic colon perforation results in decreased morbidity, decreased length of stay, and a shorter incision length compared to an open method. In those cases where it is feasible and the surgical skills exist, a laparoscopic attempt at colon repair should probably be the initial clinical approach.