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Laparoscopic suture of colonic perforation after colonoscopy

Authors

Abstract

In this video, the laparoscopic treatment of a colonic perforation following a colonoscopic screening is presented. The procedure consisted in closure of the perforation accompanied by an omentoplasty.

Classification

clinical cases

Keywords

Laparoscopic suture, colonic perforation after colonoscopy

Media type

Duration

03'00''

Publication

2009-09

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E-publication

WeBSurg.com, Sept 2009;9(09).
URL: http://www.websurg.com/doi-vd01en2716.htm

Laparoscopic suture of colonic perforation after colonoscopy

1. Clinical case presentation 00'08''

We present the laparoscopic treatment of a colonic perforation following a colonoscopic screening. This is a 78-year-old female patient with a previous surgical history of hepatitis C and appendicectomy, who benefited of a colonoscopic screening during which a perforation occurred at the level of the sigmoid colon. Three hours after the perforation, a persistent abdominal pain with signs of abdominal irritation motivated the surgery.

2. Patient and trocar positioning 00'36''

The patient is placed in a supine position with her legs together, the surgeon stands to the patient right and the first trocar, 10mm, is placed at the level of the umbilicus. The two following 5mm trocars are placed in the right iliac fossa and in the right flank.

3. Identification of the colonic perforation 00'58''

Here we can see the size of the colic perforation located in a paramedian position to the Taenia saginata.

4. Closure of the perforation 01'06''

We begin the stitching of the colic perforation by performing an interrupted suture with 3/0 absorbable PDS material. The stitches are performed in a transversal fashion to diminish the risk of stenosis at the level of the colonic lumen. The first stitches are placed on the superior and inferior edges of the perforation, and the next stitches are placed to diminish the perforation’s diameter and obtain complete water-tightness. These types of perforations can be treated medically, but persistent abdominal pains, hyperleukocytosis or other signs of serious complications usually lead us to carry out a laparoscopic treatment.

5. Omentoplasty 02'44''

The final surgical step is to perform an omentoplasty: we will place the omentum in front of the perforation. The patient resumed food intake on the first postoperative day and was discharged on the third postoperative day.

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