ELECTIVE CONVENTIONAL COLECTOMY IN THE ERA OF LAPAROSCOPIC SURGERY

Laparoscopic surgery, since its introduction into the general surgery, has reduced hospital stay. Can lessons learned from laparoscopic surg ery about aggressive postoperative care be applied to elective convent ional colectomy? Between August 1994 and February 1995, a prospective study was conducted on 24 consecutive patients undergoing elective con ventional colectomy with primary anastomosis. A comparison of 30 conse cutive patients in the 7 months immediately before this study were use d as a historical control group. Both groups were comparable in age, i ndications for operation, type of operation, and operative time. The p rotocol consisted of an outpatient bowel prep, hospital admission on d ay of surgery, and intravenous metoclopramide starting before the oper ation and continued every 6 hours with diet started at 24 hours. Patie nts were discharged on regular diet after a bowel movement and were co ntinued on oral metoclopramide for a total of 7 days. Hospital stay wa s reduced from 8 days (range 4-19 days) to 4 days (range 2-7 days) on the protocol (P < 0.001). Hospital charges were also reduced by 20 per cent (from $18,450 to $14,586) (P=0.066). Complication rate and posto perative emergency room visits as a measure of duality of care did not differ between the two groups. By implementing this protocol, hospita l costs and length of stay for elective conventional colectomy were re duced without compromising patient care.