Purpose. We present our experience with laparoscopic colorrhaphy as definitive surgical modality for the management of colonoscopic perforations. Methods. Over a 17-month period, we assessed the outcomes of consecutive patients presenting with acute colonoscopic perforations. Patient characteristics and perioperative parameters were tabulated. Postoperative outcomes were evaluated within 30 days following discharge. Results. Five female patients with a mean age of 71.4 ± 9.7 years (range: 58–83), mean BMI of 26.4 ± 3.4？kg/m2 (range: 21.3–30.9), and median ASA score of 2 (range: 2-3) presented with acute colonoscopic perforations. All perforations were successfully managed through laparoscopic colorrhaphy within 24 hours of development. The perforations were secondary to direct trauma or thermal injury and were localized to the sigmoid or cecum . None of the patients required surgical resection, diversion, or conversion to an open procedure. No intra- or postoperative complications were encountered. The mean length of hospital stay was 3.8 ± 0.8 days (range: 3–5). There were no readmissions or reoperations. Conclusion. Acute colonoscopic perforations can be safely managed via laparoscopic primary repair without requiring resection or diversion. Early recognition and intervention are essential for successful outcomes. 1. Introduction Iatrogenic perforation represents an uncommon yet potentially life-threatening complication during colonoscopy [1, 2]. Traditionally, patients have required open surgery with either primary repair of the perforation or bowel resection with or without ostomy creation [1, 3, 4]. Although these procedures are an effective approach, they often require large open incisions and may be associated with high complication rates, such as wound infection and hernias [1, 4]. In addition, the open approach usually results in slower recovery with longer hospital stay [5–7]. Minimally invasive colorectal surgery represents an efficacious alternative to the open approach, utilizing smaller incisions and resulting in diminished postoperative pain, earlier recovery, and lower postoperative morbidity [5–9]. Laparoscopic intervention has more recently been reported for the definitive treatment of acute colonoscopic perforations. This approach has shown to be a viable option, resulting in enhanced recovery in comparison to open primary colorrhaphy [5–7]. We began utilizing minimally invasive surgical (MIS) technique for repair of colonoscopic perforations in an effort to provide a safe and efficacious alternative to an open procedure. Our aim was
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