AIM: Incomplete colonoscopy occurs in 8-10% of attempted examinations. An incomplete colonoscopy is usually followed by radiological evaluation of the large bowel to complete colonic assessment. Patients then found to have >1cm polyps represent a significant management dilemma. This study describes our experience using laparoscopy to facilitate complete colonoscopy and polypectomy in patients with fixed angulation and the success of subsequent colonoscopies.
METHODS: All patients from 2008 to 2012 with an incomplete colonoscopy due to fixed angulation and polyps detected by subsequent imaging underwent standard laparoscopy with colonic mobilisation by division of adhesions to facilitate direct vision. Completion of colonoscopy and polypectomy, intra-operative complications, post-operative morbidity and successful standard follow-up colonoscopy were studied.
RESULTS: Twelve patients underwent the procedure. Complete colonoscopy to caecum was successful in all, with a mean of 2.1 polyps per patient (range 1-5) and a mean polyp size of 22mm. One iatrogenic enterotomy was repaired immediately, with no sequelae. Ten patients have since undergone colonoscopy under sedation with complete colonic evaluation possible in nine of the patients..
CONCLUSION: Laparoscopic assisted colonoscopy allows safe polypectomy in patients with incomplete colonoscopy without the need for segmental resection. This less invasive procedure yields recovery times similar to colonoscopy alone, avoiding the morbidity of a segmental resection with the added benefit of successful routine colonoscopy in the future. This article is protected by copyright. All rights reserved.