Advantages of laparoscopic resection for ileocolic Crohn’s disease

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Abstract
Laparoscopic colorectal procedures are considered to be technically challenging, and there is a lack of consensus regarding the magnitude of their benefits. The laparoscopic approach is generally held to be more expensive. Using a model of a single procedure performed for a single indication (ileocolic resection for Crohn’s disease [CD]), we set out to demonstrate the feasibility of this procedure by determining the conversion rate, documenting the patient benefits, and performing a formal cost analysis. Consecutive cases of laparoscopic ileocolic resection for CD were identified (LAP). Case-match methodology identified a series of open laparotomy controls (OPEN) that were matched for five potential confounding criteria: age, gender, diagnosis, type of resection, and date of operation. Pre-, intra-, and postoperative details were gathered. Medical resource utilization was tracked using a standardized database, and all costs were reported in 1999 dollars. The conversion rate was 5.9%. Resolution of ileus occurred more rapidly in the LAP than in the OPEN group. The time to clears in the LAP group was a median of 0 days (range, 0–4) vs 3.0 days (range, 2–8) in the OPEN group (p=0.0001). Time to regular diet was 2.0 days (range, 1–6) in the LAP group vs 5.0 days (range, 3–12) in the OPEN group (p=0.0001). Length of hospital stay was significantly reduced in the LAP group (4.0 days [range, 2–8], vs 7.0 days [range, 3–14], p=0.0001). The LAP group had significantly lower direct costs ($8684 vs $11,373) and indirect costs ($1358 vs $2349) than the OPEN group (pp$3300 for laparoscopic patients.

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