VM85 - Combined Endo-Laparoscopic Surgery for a Complex Large Colon Polyp

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Purpose/Background: Complex colonic polyps, especially those with deep tissue invasion are at high risk for perforation during endoscopic resection and often necessitate segmental resection. This case highlights a successful laparoscopic-assisted approach to excise a large, right polyp with a full-thickness defect, avoiding resection. It emphasizes the potential for minimally invasive techniques to manage high-risk colonic lesions while preserving bowel integrity.

Methods/Interventions: A 65-year-old woman presented with a 4.8 cm tubulovillous adenoma identified on MRI. The patient doesn’t have any colonoscopy before the diagnosis. During CO₂-assisted colonoscopy, a circumferential dissection was performed using a PriorKnife after submucosal injection. However, the lesion’s deep attachment to the muscular layer resulted in a full-thickness defect. The laparoscopic conversion was undertaken, and ports were placed supraumbilical and on the left abdomen. The polyp was removed en bloc with the assistance of ligasure and taken out in an Endobag. The defect was closed using V-Loc sutures and reinforced with an omental pedicle flap.

Results/Outcomes: Frozen analysis proved no malignancy and final pathological analysis also confirmed tubulovillous adenoma with multifocal high-grade dysplasia. The specimen was negative for adenocarcinoma, and both mucosal and deep margins were dysplasia-free. The successful laparoscopic repair allowed the preservation of bowel continuity without requiring resection, and the patient recovered well postoperatively. The patient was followed up according to the ERAS protocol after surgery and was discharged on postoperative day 1. No complications were observed in the early and late periods.

Conclusion/Discussion: This case demonstrates the feasibility of minimally invasive management for complex colonic polyps. Laparoscopy enabled complete lesion excision and repair of a full-thickness defect without the need for colonic resection. This approach offers a safe and effective alternative to traditional resection in select cases, minimizing tissue disruption and preserving bowel integrity