Laparoscopic-assisted Polypectomy: A Promising Minimally-invasive Solution for Endoscopically Irresectable Polyps in Children

Abstract

Aim of the study

Small and large bowel polyps are commonly associated in children with Peutz-Jeghers syndrome (PJS) and juvenile polyposis Syndrome (JPS). A promising technique was described to identify polyps' locations laparoscopically without the need for concurrent endoscopy or digital palpation. The aim of this study is to report one center's experience in applying this laparoscopic-assisted polypectomy technique (LAPT).

Methods

Prospective review of patients’ records was performed for patients <18 years who underwent LAPT in a tertiary center over a 13-year period. Data collected included demographics, Diagnosis, post-operative complications, histopathology and follow-up. Patients >18 years and/or those who had endoscopic polypectomy were excluded.

Main results

Seventeen patients underwent 19 LAPs between 2011 and 2024 at a Median age of 12 years. M:F = 3:14. Fourteen patients presented with PJS and 3 presented with JPS. All Patients underwent endoscopic assessment and were considered unsuitable for advanced-skill polypectomy based on size, location or risk of perforation from invaginated muscularis mucosa. LAPT was performed in 15 patients and laparoscopic-assisted right hemicolectomy in 2 presenting with cecal polyps. Polyps were easily identified intra-operatively with associated serosal indentation or previous tattooing. There were no conversions to open. Histopathology was benign, except in one JPS patient who had Tubulo-villous adenoma. Median hospital stay was 5 days. Patients were followed-up 6–8 weeks post-operatively and had no late complications.

Conclusions

LAPT is efficient and safe for excision of intestinal polyps that have a higher perforation risk if removed endoscopically. It eliminates the need for concurrent endoscopy or digital palpation.