Purpose: The benefits of laparoscopic colectomy (LC) over open colectomy (OC) for a variety of conditions have been well characterized. Whether the relative benefits of the minimally invasive approach differ for different conditions has not been previously investigated. The aim of this study is to identify whether there are differences in benefits with LC for colon cancer (CC), Crohn’s Disease (CD) and diverticular disease (DD). Methods: Data of patients with DD, CC, and CD undergoing elective colectomy from 2000 and 2007 were identified from a prospectively maintained IRB database. Patients with CC, CD and DD were matched 1LAP:1OC for gender, BMI, surgical procedure, ASA class and date of surgery. TNM stage was also a match criterion for CC patients. Fisher’s exact, Chi squared and Wilcoxon rank-sum tests were used for analysis and interaction p value used to compare the relative benefit of LC over OC for the different diagnoses.Results: 289 LC patients were matched to 289 OC patients. Median age was 49(14-91) years in LC and 52(15-90) years in OC (p=0.35). All other matched variables were also similar in both groups. 34(13%) LC patients underwent conversion to OC. LC had significantly shorter length of stay (LOS) (3(1-70) vs. 6(1-37) days) (p<0.001) and lower estimated blood loss (EBL) (100(10-1750) vs. 200(10-1700) cc) (p<0.001) when compared with OC. Mean operative time was similar (LC: 153±78min vs. OC: 146±71min (p=0.54). For LC patients, the conversion rate was significantly lower for DD (1(2%) patients) when compared to CC (17(19%)) and CD (16(14%)) (Interaction p=0.008). Improvement in EBL with LC was least pronounced in CD and most pronounced in DD (Interaction p<0.001). The incidence of post operative complications was also reduced in LC patients, among those with DD (p=0.09). See table.Conclusion: LC results in reduced length of stay and estimated blood loss with similar complications rates when compared to OC. The benefits of LC are more pronounced in DD when compared with CD and CC.
LC vs. OC by diagnosis

Variable	Colon Cancer N=186			Diverticular Disease N=112			Crohn’s Disease N=280
	LC N=93	OC N=93	p	LC N=56	OC N=56	p	LC N=140	0C N=140	p
Age (years)†	64 (29-91)	69 (29-88)	0.11	53(32-84)	62(37-91)	0.003	38(14-78)	37(14-70)	0.26
Males*	51(55)	55(59)	0.55	35(62)	23(41)	0.024	65(49)	54(58)	0.19
LOS days†	3(1-51)	7(1-26)	<0.001	3(1-9)	6(2-37)	<0.001	3(1-70)	6(2-28)	<0.001
EBL cc†	110(10-400)	200(10-800)	<0.001	100(25-350)	350(50-1700)	<0.001	125(10-1750)	150(10-1000)	0.034
Conversion*	17(19)	xxx	xxx	1(2)	xxx	xxx	13(13)	xxx	xxx
Intraop. Complication *	1(1)	2(2)	0.67	0(0)	2(4)	0.11	6(4.5)	3(3)	0.74
Postop Complication*	18(19)	20(10)	0.72	4(7)	15(27)	0.009	69(30)	44(33)	0.42
30 days mortality*	2(2)	1(1)	1	0	0	1	0	0	1

* Values Expressed in absolute numbers and percentages† Values expressed in medians and ranges