Sileri Pierpaolo, Sthory Roberto, McVeigh Enda, Child Tim, Cunningham Chris, Mortensen Neil J, Lindsey Ian
Department of Colorectal Surgery, John Radcliffe Hospital, University of Oxford, Oxford, UK.
J Gastrointest Surg. 2008 Jul;12(7):1239-45. doi: 10.1007/s11605-008-0481-3. Epub 2008 Feb 16.
Open ileal pouch surgery leads to high rates of adhesive small-bowel obstruction (SBO). A laparoscopic approach may reduce these complications. We aimed to review the incidence of adhesive SBO-related complications after open pouch surgery and to model the potential financial impact of a laparoscopic approach purely as an adhesion prevention strategy.
We reviewed cases of open ileal pouch patients kept on a database and examined annually. Case notes were studied for episodes of adhesive SBO requiring admission or reoperation. Similar parameters were studied in a small series undergoing laparoscopic pouch surgery. The financial burden of the open access complications was estimated and potential financial impact of a laparoscopic approach modeled.
Two hundred seventy-six patients were followed up after open surgery (median, 6.3; range, 0.2-20.1 years). There were 76 (28%) readmissions (median length of stay, 7.4 days) in 53 patients (19%) and 28 (10%) reoperations (43% within 1 year). Laparoscopic patients required less adhesiolysis at second-stage surgery (0% vs 36%, p < 0.0001) and had less SBO episodes within 12 months of surgery (0% vs 14%, p < 0.0001) than open patients. Modeling a laparoscopic approach cost $1,450 and saved $3,282, thus netting $1,832 per pouch constructed.
Open ileal pouch surgery results in significant cumulative long-term access-related complications, particularly adhesions. These impose a large medical burden on patients and financial burden on health-care systems, all of which may be recouped by a laparoscopic approach, despite higher theater costs.
开放性回肠储袋手术导致粘连性小肠梗阻（SBO）的发生率很高。腹腔镜手术方法可能会减少这些并发症。我们旨在回顾开放性储袋手术后粘连性SBO相关并发症的发生率，并模拟腹腔镜手术方法单纯作为一种粘连预防策略的潜在财务影响。
我们回顾了数据库中记录并每年检查的开放性回肠储袋患者病例。研究病历以查找需要入院或再次手术的粘连性SBO发作情况。在一小系列接受腹腔镜储袋手术的患者中研究了类似参数。估计了开放性手术并发症的财务负担，并模拟了腹腔镜手术方法的潜在财务影响。
276例患者接受开放手术后接受随访（中位数为6.3年；范围为0.2 - 20.1年）。53例患者（19%）中有76例（28%）再次入院（中位住院时间为7.4天），28例（10%）进行了再次手术（43%在1年内）。与开放手术患者相比，腹腔镜手术患者在二期手术时所需的粘连松解较少（0%对36%，p < 0.0001），且在手术后12个月内发生SBO发作的情况较少（0%对14%，p < 0.0001）。模拟腹腔镜手术方法成本为1450美元，节省了3282美元，因此每个构建的储袋净赚1832美元。
开放性回肠储袋手术会导致显著的累积长期手术相关并发症，尤其是粘连。这些给患者带来了巨大的医疗负担，给医疗保健系统带来了财务负担，尽管手术成本较高，但腹腔镜手术方法可能会弥补所有这些负担。
