Leicher Laura W, de Vos Tot Nederveen Cappel Wouter H, van Westreenen Henderik L
1 Department of Gastroenterology and Hepatology, Isala, Zwolle, Netherlands 2 Department of Surgery, Isala, Zwolle, Netherlands.
Dis Colon Rectum. 2017 Mar;60(3):299-302. doi: 10.1097/DCR.0000000000000716.
Combined endoscopic laparoscopic surgical removal is used for polyps in the colon that are not suitable for endoscopic removal because of size, location, or scarring. However, the placement of a linear stapler can be challenging. Currently a wedge resection is mostly documented in the cecum or ascending colon.
We report on our experience with limited endoscopy-assisted wedge resections in the entire colon.
A retrospective study was performed.
This was a single-center study.
Eight patients were included between March 2015 and April 2016.
The laparoscopic surgical technique consisted of placing a suture under endoscopic view through the base of the polyp into the lumen. Subsequently, traction was given on the suture to enable stapling of a wedge of the colon.
Medical data were collected (ie, indication for referral for surgery, location and size of the polyp, duration of surgical procedure, length of hospital stay, and perioperative and postoperative complications). Operative time was defined as the total time of general anesthesia.
Eight patients, with a mean age of 74.5 years (range, 68.0-82.0 years), were treated. The main indications for laparoscopic resection were the size and difficult location of the polyp. There were no complications. Mean operative time was 132 minutes. Five patients were discharged the day after surgery, and the other 3 patients were admitted for a total of 2 days.
The study was limited by its small sample size.
Our study found that limited endoscopy-assisted wedge resection is a feasible and easy technique for the removal of colon polyps and residual adenomatous tissue in scars that are not accessible for endoscopic removal. Because of traction given on the suture through the base of the polyp, the linear stapler is easily used for wedge resections of polyps, even for those that are not in favorable positions.
对于因大小、位置或瘢痕而不适于内镜切除的结肠息肉，采用内镜联合腹腔镜手术切除。然而，线性吻合器的放置可能具有挑战性。目前，楔形切除术大多记录于盲肠或升结肠。
我们报告在整个结肠进行有限的内镜辅助楔形切除术的经验。
进行一项回顾性研究。
这是一项单中心研究。
2015年3月至2016年4月纳入8例患者。
腹腔镜手术技术包括在内镜直视下通过息肉基底部将缝线置入肠腔。随后，牵拉缝线以进行结肠楔形吻合器缝合。
收集医疗数据（即手术转诊指征、息肉的位置和大小、手术时间、住院时间以及围手术期和术后并发症）。手术时间定义为全身麻醉的总时长。
治疗8例患者，平均年龄74.5岁（范围68.0 - 82.0岁）。腹腔镜切除的主要指征是息肉的大小和位置不佳。无并发症发生。平均手术时间为132分钟。5例患者术后次日出院，另外3例患者共住院2天。
本研究受样本量小的限制。
我们的研究发现，有限的内镜辅助楔形切除术是一种可行且简便的技术，用于切除内镜无法触及的瘢痕中的结肠息肉和残留腺瘤组织。由于通过息肉基底部牵拉缝线，线性吻合器易于用于息肉的楔形切除，即使对于位置不佳的息肉也是如此。
