Advantages of laparoscopic resection for ileocecal Crohn's disease.
OBJECTIVE
Elective laparoscopic-assisted resection of terminal ileal Crohn's disease is slowly gaining acceptance as an alternative to conventional surgery, based on the advantages of earlier return of bowel function, reductions in length of stay, and smaller wounds in a population likely to require reoperation. There is limited documentation of the cost-effectiveness of this approach, particularly with the reported longer operating times. The purpose of this study was to compare laparoscopic and open resections for terminal ileal Crohn's disease.


METHODS
We compared contemporaneous cohorts of patients undergoing initial elective laparoscopic or open resection for ileocecal Crohn's disease between June 1, 1999 and October 31, 2000 at a single institution. Operative approach was at the discretion of the surgeon. Data collected included age, gender, body mass index, American Society of Anesthesiologists score, indication for surgery, morbidity, mortality, conversion (laparoscopic-resection group only), operating-room time, length of hospital stay, direct cost per case, 30-day readmission, and return to work. All data are presented as medians and interquartile ranges. Data analysis was performed with the Mann-Whitney U test, Fisher's exact test, and Student's t-test where appropriate. Significance was set at P < 0.05.


RESULTS
There were 45 evaluable patients (laparoscopic-resection group, 21; open-resection group, 24). One procedure was considered a conversion because of the 13-cm incision required to exteriorize the phlegmon (conversion rate, 4.8 percent). The median age (laparoscopic-resection group, 31 years; open-resection group, 39 years) and gender distributions (male/female: laparoscopic-resection group, 129; open-resection group, 915) were significantly different between the two groups. Resumption of oral intake (operating-room day vs. second postoperative day; P < 0.05) and resumption of intestinal function (2 vs. 4 days; P < 0.05) were significantly faster in the laparoscopic-resection patients. The median length of hospital stay was significantly shorter for the laparoscopic-resection patients (3 (2-3) vs. 5 (4-6) days; P < 0.05). The 30-day readmission rate in the laparoscopic-resection group was 9.6 percent (221), whereas none of the open-resection patients required rehospitalization. The overall complication rates were comparable for the laparoscopic-resection and open-resection patients (14.3 vs. 16.7 percent; P not significant), although there was one anastomotic leak and one intra-abdominal abscess in the laparoscopic-resection group, requiring readmission and reintervention (9.6 percent; P not significant). The direct cost per case was significantly lower for the laparoscopic-resection group ($2,547 vs. $2,985; P < 0.05, Student's t-test).


CONCLUSIONS
The laparoscopic-assisted approach to ileocecal Crohn's disease results in a shortened length of stay and seems economically advantageous to open surgery.
Duepree
Hans-Joachim
HJ
Department of Colorectal Surgery and The Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Senagore
Anthony J
AJ
Delaney
Conor P
CP
Brady
Karen M
KM
Fazio
Victor W
VW
D000328:Adult; D002432:Cecum / Q000601:surgery; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D003424:Crohn Disease / Q000191:economics / Q000601:surgery*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D018709:Statistics, Nonparametric; D016896:Treatment Outcome