Minimally Invasive Treatment of Colon Perforations Associated with Colonoscopy

Abstract

Introduction: Although exploratory laparotomy was the treatment of choice for colon perforations associated with colonoscopy for many years, there is now growing evidence to support minimally invasive treatment options as the ideal choice.

Objective: To evaluate the effectiveness of minimally invasive treatment of iatrogenic colon perforations associated with colonoscopies.

Methods: A retrospective case series study was conducted with patients with colon perforations associated with colonoscopy, treated at the National Center for Minimally Invasive Surgery from January 2014 to December 2019. The sample consisted of 12 patients who underwent minimally invasive surgery. The variables evaluated were type of colonoscopy, patient demographics, time elapsed between perforation, diagnosis, and treatment, characteristics of the perforations, therapy performed, surgical time, hospital stay, and complications.

Results: A total of 5,621 colonoscopies were performed. Twelve patients (0.21%) suffered colon perforation. Minimally invasive treatment was used as the initial therapeutic modality in 100% of perforations, with an effectiveness of 91.7% due to laparoscopic resolution in 10 patients and intraluminal resolution in another. In one patient, conversion to open surgery was necessary. The most commonly used surgical technique was laparoscopic primary suture (58.3%). Suture dehiscence was observed in one patient (9.1%).

Conclusions: Minimally invasive treatment of colon perforations associated with colonoscopy is effective due to its high feasibility and low morbidity.