Laparoscopically monitored colonoscopic polypectomy:: an established form of endoluminal therapy for colorectal polyps

Background: Benign polyps, the most common disorders of the colon, are considered by many to be premalignant lesions. Colonoscopy is widely used to remove the majority of these polyps. However, a variety of "difficult polyps'' are not accessible for colonoscopic removal because of their location and size, the tortuosity of the colon, or the complexity of the lesion ( sessile vs pedunculated). In the past, a formal segmental resection usually was suggested for these difficult polyps. Methods: For 110 patients with a median age of 73 years, a total of 149 polyps were removed as follows: 88 from the right colon, 18 from the transverse colon, 10 from the left colon, and 33 from the rectosigmoid colon. Pathologic evaluation showed adenomatous polyps in 13 patients ( 11.81%), hyperplastic polyps in 1 patient ( 0.9%), adenocarcinomas in 10 patients ( 9.09%), carcinoma in situ in 1 patient ( 0.9%), and adenomas in the remaining patients ( tubulovillous, 40.18%; villous, 19.31%, and tubular, 17.77%). All the specimens were evaluated for margins and depth of resection. Results: The median size of the polyps was 2.30 cm ( range, 0.2 - 6 cm). The average hospital stay was 1.14 days, with a liquid diet started 6 h postoperatively. Mild abdominal pain/ trocar- site pain was the most common complaint. The patients were followed with colonoscopy 6 months postoperatively and yearly thereafter. Conclusions: A combined endoscopic - laparoscopic approach provides a valid alternative for treating difficult colonic polyps and eliminating the morbidity of a segmental resection. This approach seems to be safe and effective.