Can laparoscopy reduce hospital stay in the treatment of Crohn's disease?
OBJECTIVE
The aim of this article was to investigate the safety, outcome, length of stay, and cost of hospital admission in patients with Crohn's disease who underwent laparoscopy compared with open surgery.


METHODS
Among 51 consecutive patients with inflammatory bowel disease (1996-2000), 46 with Crohn's disease were included in this nonrandomized prospective study. Of these, 20 patients underwent laparoscopic surgery and 26 underwent open surgery. Data collected included the following information: age, gender, body mass index, diagnosis, duration of disease, preoperative medical treatment, previous abdominal surgery, present indication for surgery, and procedure performed (comparability measures), as well as conversion to open surgery, operating time, time to resolution of ileus, morbidity, duration of hospital stay, and cost of hospital admission (outcome measures).


RESULTS
There was no significant difference with respect to comparability measures between the laparoscopic and the open-surgery groups. There was no mortality. There was no intraoperative complication in either group and no conversion in the laparoscopic group. Operating time was significantly longer in the laparoscopic group (302 minutes) vs. the open group (244.7 minutes) (P < 0.05), but this difference disappeared when data were adjusted for the extra time required to perform the laparoscopic hand-sewn anastomoses (288.2 minutes vs. 244.7 minutes). Bowel function returned more quickly in the laparoscopic group vs. the open group in terms of passage of flatus (3.7 vs. 4.7 days) (P < 0.05) and resumption of oral intake (4.2 vs. 6.3 day) (P < 0.01). There were significantly fewer postoperative complications in the laparoscopic group (9.5 percent) vs. the open group (18.5 percent) (P < 0.05); the length of stay was significantly shorter in the laparoscopic group (8.3 days) vs. the open group (13.2 days) (P < 0.01); and the cost of hospital admission was significantly lower in the laparoscopic group ($6106, United States dollars) vs. the open group ($9829, United States dollars) (P < 0.05).


CONCLUSIONS
There is a reduction in the postoperative ileus, length of stay, cost of hospital admission, and postoperative complication rate in the laparoscopic group. Laparoscopic surgery for Crohn's disease is safe, and it is potentially more cost-effective than traditional open surgery.
Msika
S
S
Gastrointestinal Surgical Unit, University Hospital Louis Mourier, Colombes, France.
Iannelli
A
A
Deroide
G
G
Jouët
P
P
Soulé
J C
JC
Kianmanesh
R
R
Perez
N
N
Flamant
Y
Y
Fingerhut
A
A
Hay
J M
JM
D000328:Adult; D003362:Cost-Benefit Analysis; D003424:Crohn Disease / Q000191:economics* / Q000473:pathology / Q000601:surgery*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics*; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome