In a case of jejunal intussusception secondary to a lipomatous polyp, after laparoscopic reduction of the jejunum it was noted that there was no compromise in bowel vascularity at all. Enterotomy was made and the polyp was extruded out.
To perform a safe polypectomy, should the base of the polyp be stapled or would an endoloop suffice, considering that the lipomatous polyp does not invade the muscle wall? Endoloop is certainly cheaper.
using a an endo loop for a jejunal polyp/lipoma excision may leave a small stump which may predispose for the intussusception again where as stapling will not,if the cost is a constraint probably transfixation may be an alternative.
It looks that an enterotomy made presumes the lesion benign. Hence following an enterotomy, such lipomatous polyps do not penetrate deeper than submucosa. Thus using a bipolar electro-surgical cautery and excision of this lesion to ensure sufficient hemostasis may also be equally efficient and effective technique. Close the enterotomy and come out. The specimen should be subjected to histological scrutiny. These lesions are sessile with no peduncle and one feeding vessel for the entire polyp. The bare area can be left as such.
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