Abstracts
1998 Digestive Disease Week

#1058

LAPAROSCOPIC BOWEL RESECTION IN CROHN'S PATIENTS OFFERS MANY ADVANTAGES OVER OPEN SURGERY. M.F. Kutka, M.A. Talamini, H. Kaufman, B.K. Poulose, R.C. Moesinger, Department Of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.

Laparoscopic surgery continues to evolve and provide benefits to both surgeon and patient. In this study we compared the advantages of laparoscopic bowel resection to open resection in a group of patients with Crohn's disease. Over 4 years we analyzed the course of hospital treatment for 64 patients (59% female, 97% Caucasian) at a single institution. Each patient presented with a history of Crohn's disease requiring operative intervention and was offered the option of having a laparoscopic approach. Of this intial group of 64 patients, 32% required conversion to an open procedure. This provided our comparison cohort. In the successful laparoscopic group ileocectomy was the standard procedure for most (70%), but some underwent laparoscopic large bowel (11%) or small bowel resection (7%). The remainder had a laparoscopic diverting colostomy (5%), or a combined procedure (7%). The average age of the converted resection patients was not statistically (NS) different than that for the laparoscopic patients (34.8 years vs 38.2 years). But, in the converted cases 52% did have previous bowel surgery compared with only 21% of the laparoscopic patients. This open surgery group may be reflective of a more aggressive disease subset of patients who progress to surgery more quickly. Measures of hospital outcome including, 1) decreased blood loss 126cc vs 326cc (Lap vs Open)_ 2) earlier return of bowel function 4.1 days vs 5.0 days (Lap vs Open)* 3) earlier hospital discharge 5.7 days vs 6.9 days (Lap vs Open)*, reinforced the advantages of laparoscopic bowel resection. Post-hospitalization return to normal activity was assessed using a newly developed Surgical Recovery Index. This voluntary questionnaire was sent out to all the patients (56% responded) and showed the successful laparoscopic patients returned to their baseline level of functioning within 16.9 days vs 18.2 days (NS) for the laparotomy patients. Societal costs can be significant in terms of insurance expenditure as an inpatient and time lost to business. We have shown that in certain Crohn's patients who require surgery, a laparoscopic approach may benefit both the patient and the health care provider.

* p<0.05 students t-test, _ p<0.01 students t-test

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.