Intraoperative colonoscopy does not worsen the outcomes of laparoscopic colorectal surgery: a case-matched study

Intraoperative colonoscopy is sometimes needed as an adjunct to colorectal surgery. When it is performed with laparoscopic surgery, there is the potential for prolonged bowel distension, obstructed surgical exposure, and increased morbidity. This study aimed to evaluate the overall safety and outcomes of laparoscopic colorectal procedures in which intraoperative colonoscopy was performed. The study group consisted of patients who underwent intraoperative colonoscopy during laparoscopic intestinal resection at our institution between 1995 and 2011. They were individually matched for a number of factors including age, gender, diagnosis, American Society of Anesthesiologists (ASA) physical status score, and type of surgical procedure with a cohort of patients who underwent laparoscopic intestinal resection with no intraoperative colonoscopy during the same period. Early postoperative outcomes and time to flatus and first bowel movement were compared. For the study, 30 patients (18 females) and 30 matched control subjects were identified. The study and control groups did not differ in terms of operating time (132 vs 151 min; p = 0.5), estimated blood loss (216 vs 212 ml; p = 0.9), conversion to open surgery (n = 1 vs 5; p = 0.2), time to first flatus (3 vs 4 days; p = 0.4), time to first bowel movement (4 vs 4 days; p = 0.4), reoperation (n = 0 vs 1; p = 1), length of hospital stay (6 vs 9 days; p = 0.3), overall morbidity (n = 10 vs 14; p = 0.4), or readmission (n = 0 vs 1; p = 1). The complications that developed during or after surgery were similar in the two groups. No colonoscopy-related complications or deaths occurred. Intraoperative colonoscopy does not complicate the application and outcomes of laparoscopic intestinal resection. Surgeons should perform an intraoperative colonoscopy when it is indicated during laparoscopic surgery.