Laparoscopic colonic resection in inflammatory bowel disease: minimal surgery, minimal access and minimal hospital stay.
OBJECTIVE
Laparoscopic surgery for inflammatory bowel disease (IBD) is technically demanding but can offer improved short-term outcomes. The introduction of minimally invasive surgery (MIS) as the default operative approach for IBD, however, may have inherent learning curve-associated disadvantages. We hypothesise that the establishment of MIS as the standard operative approach does not increase patient morbidity as assessed in the initial period of its introduction into a specialised unit, and that it confers earlier postoperative gastrointestinal recovery and reduced hospitalisation compared with conventional open resection.


METHODS
A case-control study was undertaken on laparoscopic resection (LR) vs open colon resection (OR) for IBD. The LR group was collated prospectively and compared with a pathologically matched historical control set. Outcomes measured included: postoperative length of stay, time to normal bowel function and postoperative morbidity. Statistical analysis was performed using spss.


RESULTS
Twenty-eight patients were investigated (14 LR, 14 OR). The two groups were matched for type of operation, type of disease and age. There were no conversions in the LR group. Morbidity and readmissions did not differ significantly between the groups. Those undergoing laparoscopic resection had a quicker return to diet (median 2 vs 4 days; P = 0.000002), time to first bowel motion (2 vs 4 days; P = 0.019) and shorter postoperative length of stay (5.5 vs 12.5; P = 0.0067).


CONCLUSIONS
These findings support the routine use of MIS for the elective surgical management of IBD in our department. Patients undergoing laparoscopic colectomies for IBD can expect faster return of gastrointestinal function and shorter hospitalisation.
Boyle
E
E
Division of Colorectal Surgery, Minimally Invasive Surgery Tallaght, Adelaide, Ireland.
Ridgway
P F
PF
Keane
F B
FB
Neary
P
P
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003082:Colectomy / Q000379:methods; D003106:Colon / Q000601:surgery*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D055815:Young Adult