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 (p<0.001). This resulted in total costs of $9895 for LAP vs $13,268 for OPEN (p<0.001).
Laparoscopic ileocolic resection for CD is feasible. There are significant postoperative benefits in terms of resolution of ileus, narcotic use, and hospital stay. This approach translates into cost savings of >$3300 for laparoscopic patients.
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Online publication: 3 April 2001
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Young-Fadok, T.M., Long, K.H., McConnell, E.J. et al. Advantages of laparoscopic resection for ileocolic Crohn’s disease. Surg Endosc 15, 450–454 (2001). https://doi.org/10.1007/s004640080078
- Ileocolic resection
- Crohn’s disease
- Laparoscopic colectomy
- Cost analysis