Intraoperative parameters including estimated blood loss (EBL), conversion to open surgery, selleck chemicals Nilotinib and complications were collected. With respect to postoperative data, return of bowel function, resumption of oral intake, complications, length of stay (LOS), secondary interventions, and readmissions within 30 days after discharge were evaluated. 2.1. Operative Technique Initial entry into the peritoneal cavity was achieved under direct visualization using an Optiview trocar (Ethicon Endo-Surgery Inc., Cincinnati, OH, USA). An additional two or three 5 mm trocars were utilized with placement dependent on the suspected location of the perforation. Laparoscopic exploration was performed and followed by identification and isolation of the site of the colonic perforation.
Any bowel spillage was aspirated, and the area was irrigated. The necrotic edges of the perforation were debrided, and colorrhaphy was performed with interrupted 3-0 Vicryl (Ethicon Inc., Somerville, NJ, USA) suture in a single layer technique. An air insufflation test was performed in all cases to confirm the integrity of the repair. 3. Results Five female patients presented with acute iatrogenic colonic perforation, which occurred during screening colonoscopy. The mean age, mean BMI, and median ASA of the patients were 71.4 �� 9.7 years (range: 58�C83 years), 26.4 �� 3.4kg/m2 (range: 21.3�C30.9kg/m2), and 2 (range: 2-3), respectively (Table 1). Three perforations were secondary to mechanical trauma and recognized during the colonoscopy, while two perforations occurred due to thermal injury and were identified within 24 hours of the colonoscopy.
The perforations were located in the sigmoid (n = 4) and cecum (n = 1). While in 3 cases the time interval between perforation and surgery was 3-4 hours, in 2 cases surgery was performed following 18 and 20 hours of perforation. Table 1 Preoperative and intraoperative parameters. All procedures were successfully performed using pure laparoscopic technique. There was no significant blood loss (range: 0�C50mL) or intraoperative complications during the procedures, and none required conversion to open surgery. Surgical resection and diversion were not required for any of the perforations. Mean resumption of oral intake and return of bowel function, as evidenced by passage of flatus, were 1.4 �� 0.5 and 1.6 �� 0.9 days, respectively (range: 1-2 days).
The average length of hospital stay (LOS) was 3.8 �� 0.8 days (range: 3�C5 days). There were no postoperative complications, and none of the patients required readmission or Cilengitide secondary operative intervention (Table 2). Table 2 Postoperative outcomes. 4. Discussion Although complications during colonoscopy are uncommon, colonic perforation represents a potentially life-threatening event that may result in peritonitis, sepsis, and multiorgan failure, thus demanding prompt diagnosis and intervention .