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Comparison of Laparoscopic Versus Open Sigmoid Colectomy for Benign and Malignant Disease At Academic Medical Centers
Zurri a. Murrell*, Marcelo W. Hinojosa, Viken Konyalian, Steven Mills, Ninh T. Nguyen, Michael J. Stamos
Surgery, University of California, Irvine Medical Center, Orange, CA

Background: Clinical studies have demonstrated advantages of laparoscopic compared to open colectomy, however few studies have examined outcomes of laparoscopic compared to open sigmoid colectomy performed at U.S. academic medical centers.
Methods: Using ICD-9 diagnosis and procedure codes, data was obtained from the University Health Consortium (UHC) Clinical Data Base for all patients who underwent laparoscopic or open sigmoid colectomy for both benign and malignant disease between 2002-2006. The data were reviewed for demographics, comorbidities, length of stay, morbidity, 30-day readmission, in-hospital mortality, and costs.
Results: A total of 10,980 patients underwent either a laparoscopic or open sigmoid colectomy. 1,006 patients (9.1%) underwent laparoscopic sigmoid colectomy. Laparoscopic sigmoid colectomy was associated with a shorter length of stay (5.31+/-4.22 vs. 7.57 +/-7.41 days, p<0.05), lower overall complication rate (18.4% vs. 26%, p <0.05), a lower 30-day readmission rate (5.47% vs. 13.89%, p<0.05), and a lower in hospital mortality (0.50% vs. 0.80%, p<0.05). When patients with malignant disease are looked at separately, there remains a significant decrease in the length of stay (6.08 +/-3.13 vs. 7.94 +/-6.87 days, p<0.05), and overall complication rate (18.24% vs. 26.93%, p<0.05) for procedures performed laparoscopically.
Conclusion: Within the context of this analysis of academic centers, laparoscopic sigmoid colectomy was associated with a shorter length of stay, a lower complication rate, a decrease in 30-day readmission rate and in hospital mortality. Moreover, the decrease in length of stay and overall complication rate maintains its significance when comparing laparoscopic versus open sigmoid resections for malignant disease.

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