Advantages of laparoscopic resection for ileocolic Crohn’s disease

Young‐Fadok, Tonia M.; Long, Kirsten Hall; McConnell, Elizabeth J.; Rey, Guillaume; Cabanela, Rosa L.

doi:10.1007/s004640080078

Cited by 172 publications

(118 citation statements)

References 14 publications

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“…However, despite advocates of this technique, few have been subjected to randomised controlled clinical trials of therapy (Stage et al, 1997;Hewett et al, 1998;Lacy et al, 2002). Nonrandomised studies have examined cost, some of which have indicated lower costs with laparoscopic surgery (Bokey et al, 1996;Philipson et al, 1997), while others have found the results to be equivocal (Falk et al, 1993;Bergamaschi and Arnaud, 1997;Joo et al, 1998;Khalili et al, 1998;Young-Fadok et al, 2001).…”

mentioning

confidence: 99%

Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial)

et al. 2006

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The short-term clinical results of the CLASICC trial indicated that clinical outcomes were similar between laparoscopic and open approaches. This study presents the short-term (3 month) cost analysis undertaken on a subset of patients entered into the CLASICC trial (682 of 794 patients). As expected the costs associated with the operation were higher in the 452 patients randomised to laparoscopic surgery (lap) compared with the 230 randomised to open procedure (open), d1703 vs d1386. This was partially offset by the other hospital (nontheatre) costs, which were lower in the lap group (d2930 vs d3176). The average cost to individuals for reoperations was higher in the lap group (d762 vs d553). Overall costs were slightly higher in the lap group (d6899 vs d6631), with mean difference of d268 (95%CI À689 to 1457). Sensitivity analysis made little difference to these results. The cost of rectal surgery was higher than for colon, for lap (d8259 vs d5586) and open procedures (d7820 vs d5503). The short-term cost analysis for the CLASICC trial indicates that the costs of either laparoscopic or open procedure were similar, lap surgery costing marginally more on average than open surgery.

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mentioning

confidence: 99%

Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial)

et al. 2006

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“…9,10 Older retrospective case-matched studies did not observe any differences between the groups with respect to complication rates. 33,34 Recent registry studies, which analyzed national databases, were able to find significant differences in minor and major complications only after statistically adjusting for severity of the disease and age. 7,8 These results may be interpreted with a growing expertise in laparoscopic surgery and associated lower complication rates.…”

Section: Postoperative Outcomementioning

confidence: 99%

Long-term outcome of laparoscopic and open surgery in patients with Crohn’s disease

Hoffmann¹,

Siebrasse²,

Schlöricke³

et al. 2017

OAS

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Aim:To investigate, via data analysis, the long-term outcome of patients who underwent either laparoscopic or open surgery for Crohn's disease. Methods: A total of 113 patients who had undergone first abdominal surgery due to Crohn's disease between January 2000 and December 2010 in a maximum care provider facility, were included in the statistical analysis. All patients provided their informed consent prior to inclusion. Data were collected from a database. Follow-up data included data from central mortality registries, general practitioners and a specialized clinic. Statistical analysis of the general patient data and the different operations and approaches were performed with the use of chi-square test, Fisher's exact test, and the Mann-Whitney U test. Results: The median follow-up period in case of open and laparoscopic surgery was found to be 9 and 6 years, respectively. Statistically significant differences were observed for the following parameters in case of open and laparoscopic surgery, respectively: age (median=44 vs. 36 years, range=15-76 vs. 15-72 years; p=0.007), urgency of operation (23 out of 34 planned vs. 6 out of 70 planned; p<0.001), year of resection (median=2003 vs. 2006, range=2000-2010 vs. 2000-2010; p=0.001). The length of stay in hospital was significantly shorter in the laparoscopic group than that of open surgery group (8 vs. 11 days, respectively; p<0.0001). We did not control for factors such as age and comorbidities in our statistical analysis. We also did not find any differences with regard to perioperative and 90-day mortality, surgical complications, length of specimen, stoma, surgical recurrence rate (10% in both groups) and number of re-admissions. Moreover, we did not find differences between patients with early operation after first symptoms and patients with long course of disease. A statistically significant difference was found for long-term mortality that was higher in the open surgery group than that of laparoscopic group (p=0.005) (the median for open surgery group was significantly higher than that of laparoscopic group). Conclusion: The outcome of laparoscopic and open surgery is at least comparable. Shorter length of hospital stay and comparable surgical recurrence rates are advantages of laparoscopy.

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“…Por exemplo, o tempo de internação tende a ser menor para as séries de doentes submetidos à laparoscopia (18)(19)(20)(21) , mas em algumas séries este tempo é equiparável (22,23) . Este dado pode ser atribuído a menor tempo de íleo paralítico em algumas series (19,20,21,22,24,25,26) , mas que discordam de outras em que este tempo também é similar (23,27) . A taxa de complicações costuma ser apontada como semelhante (18,24,26) , se não menor que nas operações abertas (28) , com raras exceções (23) .…”

Section: Custosunclassified

“…A taxa de complicações costuma ser apontada como semelhante (18,24,26) , se não menor que nas operações abertas (28) , com raras exceções (23) . Em relação à necessidade de medicação analgésica, a maioria dos estudos indicam ser menor na laparoscopia (24,25,26,28) , mas há series em que o consumo não foi significativamente diferente ( 27) .…”

Section: Custosunclassified

Acesso vídeo-laparoscópico no tratamento cirúrgico da diverticulite aguda

Sousa¹,

Neto²,

Habr‐Gama³

2006

Rev bras. colo-proctol.

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RESUMO: A revisão de conceitos baseada na literatura recente relacionada ao tratamento da doença diverticular dos cólons pelo acesso vídeolaparoscópico é apresentada ao lado das indicações de formas de tratamento clássicas. A dupla abordagem videolaparoscópica, imediata para tratamento da peritonite seguida da ressecção tornada eletiva é a modalidade nova na literatura, mas ainda não padronizada. Discutem os autores dados relativos a esta tática e de outros estudos que podem ampliar o emprego desta abordagem.Descritores: Colectomia; colectomia laparoscópica; cirurgia minimamente invasiva; doença diverticular; diverticulite. Disciplina de Coloproctologia do Departamento de Gastroenterologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de INTRODUÇÃOA alta e crescente prevalência da doença diverticular dos cólons, que atinge cerca de 60% na população acima da sétima década de vida (1) , assim como os riscos inerentes aos episódios agudos de diverticulite aguda (DA), perpetuam a discussão quanto ao seu melhor manejo.Por outro lado, a relativa baixa proporção de casos de diverticulite, torna interessante a revisão de literatura dirigida, por amplificar a análise de dados e rediscutir condutas clássicas.O tratamento de quadro agudo da doença diverticular dos cólons, manifestado com infecção, está entre os tópicos que merecem revisão, em que pese constituir somente 1% ou menos de casuísticas de portadores de doença diverticular.Da mesma forma, a discussão quanto ao diagnóstico, às medidas clínicas (jejum até recuperação do íleo paralítico, emprego de antibióticos, tipo de hidratação parenteral, repouso, prazos de observação cliínica até eventual mudança para a atitude cirúrgi-ca) e até os meandros do raciocínio relativos à fisiopatologia são atuais, mas escapam ao escopo deste trabalho, estando disponíveis em revisões minuciosas e ilustrativas (2,3) . Indicação do tratamento cirúrgicoConstitui o quadro agudo infeccioso da diverticulite aguda urgência médica que enseja variadas opções terapêuticas, uma vez que sua apresentação é também variada, em espectro contínuo desde a diverticulite propriamente dita -um divertículo e a região onde se encontra tornam-se substrato de infecção -até a peritonite fecal disseminada originada de comunicação da luz intestinal com a cavidade abdominal através de divertículo perfurado devido ao agravamento da infecção diverticular inicial. Assim, o quadro mais lo-

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Advantages of laparoscopic resection for ileocolic Crohn’s disease

Abstract: 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.

Cited by 172 publications

References 14 publications

Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial)

Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial)

Long-term outcome of laparoscopic and open surgery in patients with Crohn’s disease

Acesso vídeo-laparoscópico no tratamento cirúrgico da diverticulite aguda

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Advantages of laparoscopic resection for ileocolic Crohn’s disease

Abstract: 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.

Cited by 172 publications

References 14 publications

Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial)

Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial)

Long-term outcome of laparoscopic and open surgery in patients with Crohn&rsquo;s disease

Acesso vídeo-laparoscópico no tratamento cirúrgico da diverticulite aguda

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Long-term outcome of laparoscopic and open surgery in patients with Crohn’s disease