Removal of Colon Polyps May Not Require Resection

Laparoscopic-assisted colonoscopic polypectomy (LACP) of benign polyps requires fewer resources and is just as effective as a partial colon resection.

Researchers at Stony Brook University (SBU; NY, USA) conducted a randomized study involving 34 patients with benign right-sided polyps to undergo either LACP or laparoscopic hemicolectomy (LHC). The two groups were similar in age and gender distribution, average body mass index (BMI), American Society of Anesthesiologists (ASA) class, and history of previous abdominal surgery; polyp morphology, location, size, and histology were also similar between the two groups.

The researchers found that they were able to remove polyps in 92.9% of patients assigned to LACP, with one patient requiring conversion to LHC. In the group randomized to LHC, four patients required conversion to open laparotomy. The study also found that LACP required less time than LHC (95 vs. 179 minutes), and LACP patients lost less blood (13 vs. 63 mL). LACP patients also required less intravenous (IV) fluids, took less time to pass flatus, resumed solid food intake sooner postoperatively, and were discharged earlier.

Rates of postoperative complications, hospital readmissions, and reoperations were similar among the two groups. The researchers reported that the patients in the study will continue to undergo surveillance colonoscopies to determine whether there are any differences in their long-term outcomes. The study was presented at Digestive Disease Week (DDW), held during May 2014 in Chicago (IL, USA).

“Although LACP has clear benefits, adoption of the procedure has been slow. The biggest roadblock to performing LACP is the ability of a surgeon and gastroenterologist to coordinate their schedules,” said lead author Jonathan Buscaglia, MD, director of interventional endoscopy at SBU. “You need a good relationship between the two departments, and schedules that can accommodate being in the operating room at the same time. It’s not always the easiest thing to do.”

During LACP, surgeons use a laparoscope to mobilize the right colon to a position that will allow an endoscopist to reach, snare, and remove the benign polyps. The technique is easier to perform on the right side of the colon, since the left colon presents surgeons with several obstacles, including diverticulitis, scarring, and tight anatomy.

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