Laparoscopic endoloop technique - A novel approach of managing iatrogenic caecal perforation and literature review

Area of Science:

• Surgical Innovation
• Gastrointestinal Surgery
• Minimally Invasive Procedures

Background:

• Iatrogenic cecal perforation, a rare but severe complication post-endoscopic polypectomy, carries significant morbidity and mortality risks.
• Management strategies for colonic perforations vary due to lack of national guidelines, depending on patient condition and perforation specifics.

Purpose of the Study:

• To present a novel laparoscopic improvisation for managing post-polypectomy cecal perforation.
• To demonstrate a simple and effective endoloop technique for specific perforation sites.

Main Methods:

• A laparoscopic approach was used for a patient with acute abdomen following endoscopic polypectomy.
• A novel technique involving detachable snare ligation (endoloop) was applied to perforations near the appendicular base, ensuring healthy tissue margins.
• The procedure involved freeing the appendix and meso-appendicular base and securing three endoloops proximal to the perforation site.

Main Results:

• The patient's post-operative course was uneventful, indicating successful management.
• The described endoloop technique proved to be a simple and effective method for the specific perforation location.

Conclusions:

• Laparoscopic management of colonoscopy-related colonic perforations is considered safe and effective per WSES 2013 guidelines.
• The presented endoloop technique is a novel, simple, and effective approach limited to perforations around the appendicular base, highlighting the need for adaptable surgical techniques.