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 information regarding perioperative morbidity and the cost effectiveness of this technique. The purpose of this study is to review our first year of experience with laparoscopic colon resection. Data collected includes: age, technique (open laparotomy, laparoscopic, laparoscopic/converted open), Karnofsky score, complications, specimen size/nodes, OR time, hospital stay, and cost. This is a consecutive series of 140 elective colonic resections including 102 open laparotomies (O) and 38 laparoscopic (L) cases. The indications for surgery have included adenocarcinoma col/rect (O = 59, L = 9), diverticular disease (O = 10, L = 10), 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 were 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 laparoscopic procedures compared with either open or converted groups of patients (O = 687 ± 54 cc; L = 157 ± 19; C = 491 ± 50). Bowel function returned more quickly in the laparoscopic group compared with the other 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 laparoscopic 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 significantly lower cost associated with the successfully completed laparoscopic colectomy group (O = 14449 ± 696; L = 12131 ± 612; C = 17583 ± 1731).