Perforations of the colonic wall or splenic injury during colonoscopy are rare complications. Treatment of these complications by laparoscopy is an advisable compromise instead of an invasive surgery with a laparotomy or a noninvasive and potentially risky nonoperative therapy. All surgical procedures that can be performed by open approach can also be performed laparoscopically. We present in this report 15 patients who were treated for a perforation after colonoscopy. In addition, 2 cases of splenic injury after colonoscopy are described. Twelve perforations were sutured laparoscopically and 3 perforations were sutured via laparotomy. Except for 1 minor wound infection, there were no complications. One splenic injury was treated by spleen wrapping via an open approach due to former pancreatic surgery, and 1 injury was treated laparoscopically with a hemostypticum. Mortality was 0%. Early laparoscopic intervention is a safe and effective method in the treatment of serious complications after colonoscopy.