title: Adhesions are common and costly after open pouch surgery.
abstract: OBJECTIVE
  Open ileal pouch surgery leads to high rates of adhesive small-bowel obstruction (SBO). A laparoscopic approach may reduce these complications. We aimed to review the incidence of adhesive SBO-related complications after open pouch surgery and to model the potential financial impact of a laparoscopic approach purely as an adhesion prevention strategy.
  
  
  METHODS
  We reviewed cases of open ileal pouch patients kept on a database and examined annually. Case notes were studied for episodes of adhesive SBO requiring admission or reoperation. Similar parameters were studied in a small series undergoing laparoscopic pouch surgery. The financial burden of the open access complications was estimated and potential financial impact of a laparoscopic approach modeled.
  
  
  RESULTS
  Two hundred seventy-six patients were followed up after open surgery (median, 6.3; range, 0.2-20.1 years). There were 76 (28%) readmissions (median length of stay, 7.4 days) in 53 patients (19%) and 28 (10%) reoperations (43% within 1 year). Laparoscopic patients required less adhesiolysis at second-stage surgery (0% vs 36%, p < 0.0001) and had less SBO episodes within 12 months of surgery (0% vs 14%, p < 0.0001) than open patients. Modeling a laparoscopic approach cost $1,450 and saved $3,282, thus netting $1,832 per pouch constructed.
  
  
  CONCLUSIONS
  Open ileal pouch surgery results in significant cumulative long-term access-related complications, particularly adhesions. These impose a large medical burden on patients and financial burden on health-care systems, all of which may be recouped by a laparoscopic approach, despite higher theater costs.
authors.affiliation: Department of Colorectal Surgery, John Radcliffe Hospital, University of Oxford, Oxford, UK.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Sileri
authors.forename: Roberto
authors.initials: R
authors.lastname: Sthory
authors.forename: Enda
authors.initials: E
authors.lastname: McVeigh
authors.forename: Tim
authors.initials: T
authors.lastname: Child
authors.forename: Chris
authors.initials: C
authors.lastname: Cunningham
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Mortensen
authors.forename: Ian
authors.initials: I
authors.lastname: Lindsey
mesh_terms: D000328:Adult; D003108:Colonic Diseases / Q000601:surgery*; D039021:Colonic Pouches / Q000473:pathology*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007077:Ileal Diseases / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D015994:Incidence; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D010535:Laparoscopy / Q000191:economics* / Q000379:methods*; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D000267:Tissue Adhesions / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D006113:United Kingdom / Q000453:epidemiology