Laparoscopic vs. open surgery for the treatment of iatrogenic colonoscopic perforations: a systematic review and meta-analysis

Martínez-Pérez, Aleix; de’Angelis, Nicola; Brunetti, Francesco; Baleur, Yann Le; Llorente, Carmen Payá; Méméo, Riccardo; Gaiani, Federica; Manfredi, Marco; Gavriilidis, Paschalis; Nervi, G.; Catena, Fausto; Amiot, Aurélien; Sobhani, Iradj; de’Angelis, Gian Luigi

doi:10.1186/s13017-017-0121-x

Cited by 33 publications

(32 citation statements)

References 60 publications

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“…Iatrogenic perforation is associated with a high risk of morbidity and mortality [4,5]. It is best managed by a multidisciplinary approach, including the competences of endoscopists, radiologists, and surgeons that need to be promptly available.…”

Section: General Policymentioning

confidence: 99%

“…The type of surgical management of iatrogenic perforation (laparoscopy vs. open procedure) depends mainly on the location of the perforation and the surgeon's decision. Minimally invasive laparoscopic treatment of perforations has become the preferred surgical option for colonic iatrogenic perforation as it provides better outcomes than open surgery [4,50].…”

Section: Recommendationmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

et al. 2020

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Summary of Recommendations 1 ESGE recommends that each center implements a written policy regarding the management of iatrogenic perforations, including the definition of procedures that carry a higher risk of this complication. This policy should be shared with the radiologists and surgeons at each center. 2 ESGE recommends that in the case of an endoscopically identified perforation, the endoscopist reports its size and location, with an image, and statement of the endoscopic treatment that has been applied. 3 ESGE recommends that symptoms or signs suggestive of iatrogenic perforation after an endoscopic procedure should be rapidly and carefully evaluated and documented with a computed tomography (CT) scan. 4 ESGE recommends that endoscopic closure should be considered depending on the type of the iatrogenic perforation, its size, and the endoscopist expertise available at the center. Switch to carbon dioxide (CO2) endoscopic insufflation, diversion of digestive luminal content, and decompression of tension pneumoperitoneum or pneumothorax should also be performed. 5 ESGE recommends that after endoscopic closure of an iatrogenic perforation, further management should be based on the estimated success of the endoscopic closure and on the general clinical condition of the patient. In the case of no or failed endoscopic closure of an iatrogenic perforation, and in patients whose clinical condition is deteriorating, hospitalization and surgical consultation are recommended.

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Section: General Policymentioning

confidence: 99%

Section: Recommendationmentioning

confidence: 99%

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

et al. 2020

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“…Our study focused on verifying the efficacy and feasibility of the procedure, with the expectation that a single-incision approach could be superior to the conventional modality in terms of cosmesis, pain control, and operative outcome since it minimized the number of ports inserted into a patient's body, reducing patient operative burden. Because conventional laparoscopic procedures have become more popular in surgical fields because of their superiority in terms of safety, postoperative complication control, infection control, and cosmesis over laparotomy [19,20], our data support a single-port laparoscopic modality as a safe, efficient, and feasible alternative to the conventional multiport laparoscopic procedure. Based on the results, there was no postoperative 30-day mortality, and only 1 patient had a postoperative complication, aspiration pneumonia, because of Levin tube insertion and not because of the surgery itself.…”

Section: Discussionmentioning

confidence: 53%

Safety and Efficacy of Single-Port Laparoscopic Ileostomy in Palliative Settings

Kang

Cho²,

et al. 2020

Ann Coloproctol

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Original ArticleAnn Coloproctol 2020;36(1):17-21 https://doi.org/10. 3393/ac.2019.04.25 Purpose: Single-port laparoscopic techniques can be optimized with confined incisions. This approach has an intraoperative advantage of excellent visualization of the correct intestinal segment for exteriorization, along with direct visual control of the extraction to avoid twisting. However, only a few studies have verified the efficacy of the technique. Thus, this study assessed the results of single-port laparoscopic stoma creation for fecal diversion, specifically focusing on feasibility, safety, and efficacy. Methods: Patients who underwent single-incision enterostomy performed by a single surgeon were included. Data on demographics, indications for and chosen procedure, and operation results were retrospectively collected and analyzed. Results: Between April 2015 and January 2018, a total of 13 patients (8 males, 5 females) with a mean age of 57.7 years (range, 41-83 years) underwent single-port ileostomy creation. The most common reason for diversion was palliative ileostomy for colon obstruction or fistula from peritoneal malignancy (n = 12), followed by colonic fistula with necrotizing pancreatitis (n = 1). There were no cases of conversion to open or multiport laparoscopic surgery. The mean operative time was 54 minutes (range, 37-118 minutes), and the median length of hospital stay was 8 days (range, 2-211 days). A postoperative complication, aspiration pneumonia, was documented in 1 patient and treated conservatively. The mean duration of bowel movement was 0.7 days (range, 0-4 days). All stomas had good function, and there was no 30-day mortality. Conclusion: Single-port laparoscopic ileostomy in patients with a palliative setting could be a safe and feasible option for fecal diversion.

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“…In this series, laparoscopy was utilized in 23.5% of those patients undergoing surgery . In a recent meta analysis, laparoscopic approaches resulted in better outcomes in terms of postoperative complications and LOS in hospital …”

Section: Discussionmentioning

confidence: 99%

Treatment of colonoscopic perforation: outcomes from a major single tertiary institution

Chew

Faragher

2019

ANZ Journal of Surgery

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Background: The use of colonoscopy has been increasing in Australia. This case series describes management and outcomes of colonoscopic perforation managed by a single tertiary referral unit. Methods: An analysis of 13 years (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) of prospectively collected data on patients who had a colonoscopic perforation and were managed by the colorectal unit at a single tertiary referral centre was performed. Main outcomes were time of diagnosis, modality of management, time to theatre, length of stay, cost of admission and complications. Results: Sixty-two patients had perforations (median age of 69 years). Thirty-eight (61.2%) patients had their colonoscopy performed in another institution. The incidence rate decreased to 0.37 perforations per 1000 colonoscopies within Western Health. Overall, diagnostic colonoscopies accounted for 56% of perforations and perforations were likely to occur in the left colon (P = 0.006). Fifty-one (82%) patients underwent surgery during their admission, with 24% of these being laparoscopic procedures. An earlier diagnosis was associated with significantly less intra-abdominal contamination. Gross peritoneal contamination was more likely to be associated with the decision to form a stoma (37%, n = 19, P = 0.04). Thirty-day mortality was 1.6% (n = 1). Conclusions: Colonoscopic perforations occur in experienced hands and may have serious implications. We demonstrated a difference in patterns of injury between therapeutic and diagnostic colonoscopies. Those who have an earlier diagnosis are less likely to have severe intra-abdominal contamination requiring a stoma formation.

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Laparoscopic vs. open surgery for the treatment of iatrogenic colonoscopic perforations: a systematic review and meta-analysis

Cited by 33 publications

References 60 publications

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

Safety and Efficacy of Single-Port Laparoscopic Ileostomy in Palliative Settings

Treatment of colonoscopic perforation: outcomes from a major single tertiary institution

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