OPEN COLECTOMY VERSUS LAPAROSCOPIC COLECTOMY - ARE THERE DIFFERENCES

Laparoscopic colectomy has been increasingly reported as an option for the treatment of colonic pathology. However, there is very little inf ormation regarding perioperative morbidity and the cost effectiveness of this technique. The purpose of this study is to review our first ye ar of experience with laparoscopic colon resection. Data collected inc ludes: age, technique (open laparotomy, laparoscopic, laparoscopic/con verted open), Karnofsky score, complications, specimen size/nodes, OR time, hospital stay, and cost. This is a consecutive series of 140 ele ctive colonic resections including 102 open laparotomies (0) and 38 la paroscopic (L) cases. The indications for surgery have included adenoc arcinoma col/rect (O = 59, L = 9), diverticular disease (O = 10, L = 1 0), adenomatous polyp (O = 3, L = 7), IBD (Crohn's, CUC) (O = 15, L = 4), rectal prolapse (O = 3, L = 4), and other (O = 12, L = 4). There w ere no significant differences with respect to age (O = 60.7 +/- 1.5; L = 54.8 +/- 3.8; C = 66.1 +/- 3.1), perioperative morbidity (O = 11%; L = 15%; C = 17%). The laparoscopic and laparoscopic converted cases required significantly more time compared to the open laparotomy group (O = 2.1 +/- 0.2 hours; L = 2.9 +/-0.2; C = 3.4 +/- 0.2). There were significantly less intraoperative blood loss associated with laparosco pic procedures compared with either open or converted groups of patien ts (O = 687 +/- 54 cc; L = 157 +/- 19; C = 491 +/- 50). Bowel function returned more quickly in the laparoscopic group compared with the oth er groups (O = 4.9 +/- 0.2 days; L = 3.0 +/- 0.3; C = 4.3 +/- 0.6). In addition, the hospital stay was significantly shorter in the laparosc opic group compared with either of the other two groups (O = 9.9 +/- 0 .4 days; L = 6.0 +/- 0.5; C = 9.3 +/- 0.8). Finally, there was signifi cantly lower cost associated with the successfully completed laparosco pic colectomy group (O = 14449 +/- 696; L = 12131 +/- 612; C = 17583 1 731).