Reply to: doi:10.1007/s00464-009-0668-z: Combined laparoscopic–endoscopic resection of colorectal polyps: 10-year experience and follow-up evaluation
| العنوان: | Reply to: doi:10.1007/s00464-009-0668-z: Combined laparoscopic–endoscopic resection of colorectal polyps: 10-year experience and follow-up evaluation |
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| المؤلفون: | S von Delius, Hubertus Feussner, Dirk Wilhelm, Alexander Meining |
| المصدر: | Surgical Endoscopy. 24:733-734 |
| بيانات النشر: | Springer Science and Business Media LLC, 2009. |
| سنة النشر: | 2009 |
| مصطلحات موضوعية: | medicine.medical_specialty, Colotomy, medicine.diagnostic_test, business.industry, Colonoscopy, Endoscopic mucosal resection, Hepatology, Surgery, Follow up evaluation, Internal medicine, Open Resection, medicine, Endoscopic resection, business, Abdominal surgery |
| الوصف: | This article tries to answer the question about the feasibility of laparoscopically assisted resection of difficult ‘‘benign’’ polyps. It would have been useful if the data presented had been contextualized with regard to the number of patients who underwent alternative or open procedures? Primarily, open resection of benign, even difficult polyps, is no longer the therapy of choice and almost dispensable since the introduction of combined procedures to our department in the early 1990s. Thus, all patients received the combined approach at first. Seven patients (5%) underwent conversion to open surgery due to suspicion of malignant disease (n = 3, according to institutional policy), bowel perforation during colonoscopy (n = 1), difficult closure of the colotomy (n = 2), and incomplete resection of a rectal lesion (n = 1). This was clearly stated in the article. If the polyps were classified as endoscopically resectable in a routine preoperative endoscopic examination, this was the preferred therapy. The definition of polyps deemed unresectable by colonoscopy was accepted as subjective. However, was there any screening or repeat colonoscopy by an experienced colonoscopist? All the patients had received a colonoscopy by an experienced endoscopist before presenting to our institution. However, preoperative recolonoscopy routinely performed could preserve about 5% of patients from surgical treatment. Concrete endoscopic snare resection had even been attempted for 27 of the patients but was unsuccessful. Moreover, we note that with laparoscopic assistance, only eight polyps were endoscopically approachable, as displayed in Table 2. Voloyiannis et al. [1] found that selective colonoscopy for 171 of 252 patients referred led to avoidance of resection for 101 patients. As a result, 58% of these were rescoped, and 40% of all the patients referred avoided resection. This resection rate may improve with the relatively new technique of colonoscopic (endoscopic) mucosal resection described by Saito et al. [2]. The percentage of resections avoided by recolonoscopy was comparably low in our series, as already mentioned. However, all referring practitioners are highly experienced endoscopists, and the low avoidance rate may be due to the fact that the classification of polyps as unresectable is justified to a great extent. The technique of endoscopic submucosal dissection for large colonic adenomas, as described by Saito et al. [2], is very demanding but attracting initial interest in Japan. In the Western world, endoscopic submucosal resection still is in its infancy and not a standard procedure. Additionally, it is associated with a much higher complication rate. The authors are to be complimented for their honest appraisal of complications at 25%. D. Wilhelm (&) H. Feussner Department of Surgery, Technische Universitat Munchen, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675 Munich, Germany e-mail: wilhelm@chir.med.tu-muenchen.de |
| تدمد: | 1432-2218 0930-2794 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_________::793e79db10594f095a9cd7df54656b31Test https://doi.org/10.1007/s00464-009-0684-zTest |
| حقوق: | CLOSED |
| رقم الانضمام: | edsair.doi...........793e79db10594f095a9cd7df54656b31 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14322218 09302794 |
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