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Combined laparoscopic–endoscopic resections of colorectal polyps: 10-year experience and follow-up



Large, colorectal polyps or those that are difficult to access may be unamenable to conventional snare polypectomy and may require surgical resection. This study was designed to evaluate the resection of such lesions by the use of combined laparoscopic–endoscopic resections (CLER).


Patients who had received CLER for colorectal polyps between January 1997 and December 2006 were identified from a prospectively maintained database. Patients with biopsies consistent with invasive cancer were excluded from the combined approach. Baseline characteristics, surgical, pathological, postoperative, and follow-up data of patients and lesions were reviewed.


A total of 146 consecutive patients underwent CLER for 154 lesions, and 120 (82%) patients underwent local excision (i.e., laparoscopy-assisted endoscopic resection, endoscopy-assisted wedge resection, and endoscopy-assisted transluminal resection). Twenty-six (18%) patients received endoscopy-assisted segmental colon resection. Conversion rate was 5% and intraoperative complications occurred in two patients (1%). Major postoperative complications occurred in five patients (3%), necessitating surgical reintervention in four of them. Follow-up colonoscopy revealed metachronous adenomas in 33 patients, of which 8 patients showed macroscopic or microscopic characteristics of advanced lesions. One patient, who had been converted to open resection because of incomplete laparoscopic resection of an adenoma, developed relapse of the initial adenoma and was successfully treated with repeat CLER accounting for a local recurrence rate of 0.9%.


Combined laparoscopic–endoscopic resection is an efficient, safe, and minimally invasive alternative to open resection for selected patients with difficult polyps, but it should be restricted to benign disease.

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  1. 1.

    Levine JS, Ahnen DJ (2006) Clinical practice. Adenomatous polyps of the colon. N Engl J Med 355:2551–2557

  2. 2.

    Eijsbouts QA, Heuff G, Sietses C, Meijer S, Cuesta MA (1999) Laparoscopic surgery in the treatment of colonic polyps. Br J Surg 86:505–508

  3. 3.

    Wexner SD, Reissman P, Pfeifer J, Bernstein M, Geron N (1996) Laparoscopic colorectal surgery: analysis of 140 cases. Surg Endosc 10:133–136

  4. 4.

    Pokala N, Delaney CP, Kiran RP, Brady K, Senagore AJ (2007) Outcome of laparoscopic colectomy for polyps not suitable for endoscopic resection. Surg Endosc 21:400–403

  5. 5.

    Franklin ME Jr, Leyva-Alvizo A, Abrego-Medina D, Glass JL, Treviño J, Arellano PP, Portillo G (2007) Laparoscopically monitored colonoscopic polypectomy: an established form of endoluminal therapy for colorectal polyps. Surg Endosc 21:1650–1653

  6. 6.

    Feussner H, Wilhelm D, Dotzel V, Papagoras D, Frimberger E (2003) Combined endoluminal and endocavitary approaches to colonic lesions. Surg Technol Int 11:97–101

  7. 7.

    Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111:518–526

  8. 8.

    Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, Leppert M, Nakamura Y, White R, Smits AM, Bos JL (1988) Genetic alterations during colorectal-tumor development. N Engl J Med 319:525–532

  9. 9.

    Winawer SJ, Zauber AG, O’Brien MJ, Ho MN, Gottlieb L, Sternberg SS, Waye JD, Bond J, Schapiro M, Stewart ET et al (1993) Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. N Engl J Med 328:901–906

  10. 10.

    Tabibian N, Michaletz PA, Schwartz JT et al (1988) Use of endoscopically placed clip can avoid diagnostic errors in colonoscopy. Gastrointest Endosc 34:262–265

  11. 11.

    Botoman VA, Pietro M, Thirlby RC (1994) Localization of colonic lesions with endoscopic tattoo. Dis Colon Rectum 37:775–776

  12. 12.

    Salamon P, Berner JS, Waye JD (1993) Endoscopic India ink injection: a method for preparation, sterilization, and administration. Gastrointest Endosc 39:803–805

  13. 13.

    Hammond DC, Lane FR, Welk RA et al (1989) Endoscopic tattooing of the colon: an experimental study. Am Surg 55:457–461

  14. 14.

    Coman E, Brandt LJ, Brenner S et al (1991) Fat necrosis and inflammatory pseudotumor due to endoscopic tattooing of the colon with India ink. Gastrointest Endosc 37:65–68

  15. 15.

    Park SI, Genta RS, Romeo DP, Weesner RE (1991) Colonic abscess and focal peritonitis secondary to India ink tattooing of the colon. Gastrointest Endosc 37:68–71

  16. 16.

    Hornig D, Kuhn H, Stadelmann O, Botticher R (1983) Phlegmonous gastritis after India Ink marking. Endoscopy 15:266–269

  17. 17.

    Martel G, Boushey RP (2006) Laparoscopic colon surgery: past, present and future. Surg Clin North Am 86:867–897

  18. 18.

    Chung CC, Tsang WW, Kwok SY, Li MK (2003) Laparoscopy and its current role in the management of colorectal disease. Colorectal Dis 5:528–543

  19. 19.

    Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ (2006) Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev 4:CD006231

  20. 20.

    Coutsoftides T, Sivak MV Jr, Benjamin SP et al (1978) Colonoscopy and the management of polyps with invasive carcinoma. Ann Surg 188:638–641

  21. 21.

    O’Connell JB, Maggard MA, Ko CY (2004) Colon cancer survival rates with the New American Joint Committee on Cancer Staging, 6th edn. J Natl Cancer Inst 96:1420–1425

  22. 22.

    Laiyemo AO, Murphy G, Albert PS, Sansbury LB, Wang Z, Cross AJ, Marcus PM, Caan B, Marshall JR, Lance P, Paskett ED, Weissfeld J, Slattery ML, Burt R, Iber F, Shike M, Kikendall JW, Lanza E, Schatzkin A (2008) Postpolypectomy colonoscopy surveillance guidelines: predictive accuracy for advanced adenoma at 4 years. Ann Intern Med 148:419–426

  23. 23.

    Winawer SJ, Zauber AG, O’Brien MJ, Ho MN, Gottlieb L, Sternberg SS et al (1993) Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. N Engl J Med 328:901–906

  24. 24.

    Neugut AI, Jacobson JS, Ahsan H, Santos J, Garbowski GC, Forde KA et al (1995) Incidence and recurrence rates of colorectal adenomas: a prospective study. Gastroenterology 108:402–408

  25. 25.

    Bond JH (2003) Update on colorectal polyps: management and follow-up surveillance. Endoscopy 35:35–40

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Correspondence to Hubertus Feussner.

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Wilhelm, D., von Delius, S., Weber, L. et al. Combined laparoscopic–endoscopic resections of colorectal polyps: 10-year experience and follow-up. Surg Endosc 23, 688–693 (2009).

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  • Combined laparoscopic–endoscopic resections
  • Colorectal polyps
  • Colorectal adenoma
  • Colorectal cancer
  • Laparoscopy