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Journal of Gastrointestinal Surgery

Published in:

01-07-2008 | original article

Adhesions are Common and Costly after Open Pouch Surgery

Authors: Pierpaolo Sileri, Roberto Sthory, Enda McVeigh, Tim Child, Chris Cunningham, Neil J. Mortensen, Ian Lindsey

Published in: Journal of Gastrointestinal Surgery | Issue 7/2008

Abstract

Purpose

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.

Materials and Methods

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.

Results

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.

Conclusion

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.

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Title: Adhesions are Common and Costly after Open Pouch Surgery
Authors: Pierpaolo Sileri
Roberto Sthory
Enda McVeigh
Tim Child
Chris Cunningham
Neil J. Mortensen
Ian Lindsey
Publication date: 01-07-2008
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 7/2008
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-008-0481-3

2024 ASCO Annual Meeting

Springer Medicine

Adhesions are Common and Costly after Open Pouch Surgery

Abstract

Purpose

Materials and Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusion

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