Purpose: Although laparoscopic colectomy has demonstrated a variety of advantages, it remains unclear whether the reductions in length of stay and faster return of bowel function will offset potential increases in cost caused by operating time and instrumentation. The purpose of this study was to compare the direct cost structure of elective open and laparoscopic resection for sigmoid diverticulitis.
Methods: We compared consecutive elective open and laparoscopic sigmoid colectomies (n = 71 and n = 61, respectively) performed from March 1, 1999, through December 31, 2000. Data collected included age, gender, body mass index, American Society of Anesthesia score, indication for surgery, morbidity, mortality, conversion (laparoscopic only), operating time, and length of hospital stay. Direct cost data were provided by Stanford's integrated hospital cost management and decision software. Indirect costs and total costs were not addressed. Data were analyzed by Student's t-test and chi-squared test where appropriate. Significance was set at P < 0.05. All data are presented as mean +/- standard error of the mean.
Results: There were 132 elective sigmoid colectomies for diverticular disease (61 laparoscopic and 71 open procedures). There were no significant differences between the groups with respect to age, male/female ratio, or body mass index. Operating time was similar (109 +/- 7 minutes for laparoscopic procedures vs. 101 +/- 7 minutes for open procedures). The laparoscopic group had a significantly shorter length of stay (3.1 +/- 0.2 vs. 6.8 +/- 0.4 days), fewer pulmonary complications (1 (1.6 percent) vs. 4 (5.6 percent)) and fewer wound infections (0 vs. 5 (7 percent)). Conversion to open colectomy was required in 4 (6.6 percent) of 61 patients. Readmission occurred in three laparoscopic colectomy patients (4.9 percent) and four open colectomy patients (5.6 percent). There was one operative death in the laparoscopic group (1.6 percent) and no deaths in the open group. Total direct cost per case was significantly less for laparoscopic procedures ($3,458 +/- 437) than for open colectomies ($4321 +/- 501; P < 0.05, Student's t-test), and operating costs were not significantly different between the groups.
Conclusion: The data demonstrate that laparoscopic colectomy is a cost-effective means of electively managing sigmoid diverticular disease. This operative approach may become very important in an era of increasing constraints on hospital occupancy rates and access to nursing services in many regions of the country.
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http://dx.doi.org/10.1007/s10350-004-6225-x | DOI Listing |
Updates Surg
January 2025
Department of Gastrointestinal Surgery, The First People's Hospital of Foshan, No. 81 Lingnan Avenue North, Foshan, China.
The surgical risk is higher for obese patients undergoing laparoscopic left hemicolectomy. To enhance the surgical safety and efficacy for obese patients, we have innovatively integrated the advantages of various surgical approaches to modify a pancreas-guided C-shaped surgical procedure. The safety and quality were assessed through a retrospective analysis.
View Article and Find Full Text PDFLangenbecks Arch Surg
January 2025
Department of General Surgery, Hangzhou Hospital of Traditional Chinese Medicine, No. 453 Ti-Yu-Chang Road, Hangzhou, Zhejiang, 310007, People's Republic of China.
Objective: To study the effect of transversus abdominis plane (TAP) block under direct vision with acupoint injection on the rapid recovery of patients after laparoscopic cholecystectomy.
Methods: Ninety-three patients undergoing laparoscopic cholecystectomy at Hangzhou Hospital of Traditional Chinese Medicine from January 2023 to December 2023 were selected and divided into control, TAP block under direct vision (TAP-DV), and TAP-DV with acupoint injection (TAP-DVA) groups using a random number table method. Postoperative VAS, Ramsay score, IL-6, CRP, and postoperative rehabilitation indices were compared among the three groups.
J Coll Physicians Surg Pak
January 2025
Department of General and Laparoscopic Surgery, Sheikh Khalifa Bin Zayed Al-Nahyan Hospital Muzaffarabad, Azad Jammu and Kashmir, Pakistan.
Objective: To determine the importance of the Glasgow Coma scale (GCS), ASA physical status classification system, and P-POSSUM score in predicting mortality among patients undergoing emergency laparotomies.
Study Design: An analytical study. Place and Duration of the Study: Department of General Surgery, Sheikh Khalifa Bin Zayed Al-Nahyan Hospital Muzaffarabad, Pakistan, from October 2020 to January 2022.
Eur J Med Res
January 2025
Department of Anesthesiology, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, No. 120, Longshan Road, Yubei District, Chongqing, 401147, China.
Background: Postoperative pain intensity is influenced by various factors, including genetic variations. The SCN10A gene encodes the Nav1.8 sodium channel protein, which is crucial for pain signal transmission in peripheral sensory neurons.
View Article and Find Full Text PDFBMC Surg
January 2025
Department of Cardiothoracic Surgery, Fifth Affiliated Hospital of Sun Yat-Sen University, No.52 East Meihua Road, Zhuhai, Guangdong Province, 519000, China.
Background: Laparoscopic-assisted single-port mediastinoscopic esophagectomy is a safe and effective emerging minimally invasive esophagectomy, but little has been reported about the learning curve for this technology. The goal of the study was to determine the number of procedures to achieve different levels of proficiency on the learning curve.
Methods: This study retrospectively analyzed data from consecutive surgeries performed by the same surgeon at the same center from 2016 to 2021.
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