Combined endoscopic and laparoscopic removal of colonic polyps

Conversion to open surgery was needed in 5% (7/146) of patients in a case series of 146 patients treated by various combined endoscopic and laparoscopic approaches (including laparoscopic‑assisted endoscopic polypectomy [n=8], endoscopy‑assisted wedge resection [n=72], endoscopy‑assisted transluminal resection [n=40] and endoscopy‑assisted segmental resection [n=26]). The reasons for conversion to open surgery were 3 incidents of suspected malignant tumours, 1 bowel perforation, 2 difficult closures of the resection site and 1 incomplete resection of a polyp.

Conversion to a 'formal resection' was needed in 2% (4/176) of patients in a case series of 176 patients treated by laparoscopic‑monitored endoscopic polypectomy, because of failure of the combined approach: the authors did not state whether formal resection was performed laparoscopically or by open surgery.

Wound infections were observed in 10% (14/146) of patients in the case series of 146 patients treated by various combined endoscopic and laparoscopic approaches. In the same study, intra‑abdominal abscesses were reported in 3% (4/146) of patients: CT‑guided drainage of abscesses was needed in 3 patients and 1 patient needed reoperation.

Postoperative bleeding, which resolved with conservative treatment, was reported in 3% (1/30) of patients in a case series of 30 patients treated by laparoscopic‑assisted endoscopic polypectomy: details of treatment were not provided. In the same study, urinary retention was observed in 7% (2/30) of patients.

Atelectasis was reported in 5% (9/176) of patients in a case series of 176 patients treated by laparoscopic‑monitored endoscopic polypectomy (time of occurrence not reported). In the same study, seroma was observed in 2% (3/176) of patients and ileus was observed in 2% (4/176) of patients.

Specialist advisers stated that inflammatory responses to tattoo ink in adjacent tissues, difficulty with laparoscopy because of gross colonic distension from colonoscopy and bleeding after polypectomy were anecdotal adverse events. Specialist advisers listed theoretical adverse events as incomplete resection, bleeding that may be difficult to control intraluminally, bowel perforation, anastomotic leak, faecal contamination, infection, missed malignancy, tumour spillage and loss of colonic circumference rendering simple closure difficult or impossible.