Can laparoscopy reduce hospital stay in the treatment of Crohn's disease?

PURPOSE: The aim of this article was to investigate the safety, outcome, le ngth of stay, and cost of hospital admission in patients with Crohn's disea se who underwent laparoscopy compared with open surgery. METHODS: Among 51 consecutive patients with inflammatory bowel disease (1996-2000), 46 with C rohn's disease were included in this nonrandomized prospective study. Of th ese, 20 patients underwent laparoscopic surgery and 26 underwent open surge ry. Data collected included the following information: age, gender, body ma ss index, diagnosis, duration of disease, preoperative medical treatment, p revious abdominal surgery, present indication for surgery, and procedure pe rformed (comparability measures), as well as conversion to open surgery, op erating time, time to resolution of ileus, morbidity, duration of hospital stay, and cost of hospital admission (outcome measures). RESULTS: There was no significant difference with respect to comparability measures between t he laparoscopic and the open-surgery groups. There was no mortality. There was no intraoperative complication in either group and no conversion in the laparoscopic group, Operating time was significantly longer in the laparos copic group (302 minutes) vs. the open group (244.7 minutes) (P < 0.05), bu t this difference disappeared when data were adjusted for the extra time re quired to perform the laparoscopic hand-sewn anastomoses (288.2 minutes vs. 244.7 minutes). Bowel function returned more quickly in the laparoscopic g roup vs. the open group in terms of passage of flatus (3.7 vs. 4.77 days) ( P < 0.05) and resumption of oral intake (4.2 vs, 6.3 day) (P < 0.01). There were significantly fewer postoperative complications in the laparoscopic g roup (9-5 percent) vs. the open group (18.5 percent) (P < 0.05); the length of stay was significantly shorter in the laparoscopic group (8.3 days) us. the open group (13.2 days) (P < 0.01); and the cost of hospital admission was significantly lower in the laparoscopic group ($6106, United States dol lars) vs. the open group (S9829, United States dollars) (P < 0.05). CONCLUS ION: There is a reduction in the postoperative ileus, length of stay, cost of hospital admission, and postoperative complication rate in the laparosco pic group. Laparoscopic surgery for Crohn's disease is safe, and it is pote ntially more cost-effective than traditional open surgery.