Open Right Colectomy Is Still Effective Compared to Laparoscopy
| Autor: | Walter Zuliani, Valerio Di Carlo, Marco Braga, Andrea Vignali, Matteo Frasson |
|---|---|
| Přispěvatelé: | Braga, M, Frasson, M, Vignali, A, Zuliani, W, Di Carlo, V, Braga, Marco, Vignali, Andrea, Di Carlo, V. |
| Rok vydání: | 2007 |
| Předmět: |
Male
medicine.medical_specialty Colonic Disease Randomization Cost-Benefit Analysis medicine.medical_treatment Follow-Up Studie law.invention Colonic Diseases Randomized controlled trial law Laparotomy medicine Humans Cost-Benefit Analysi Laparoscopy Colectomy Aged medicine.diagnostic_test business.industry Mortality rate Middle Aged Surgery Clinical trial Treatment Outcome Right Colectomy Quality of Life Female business Follow-Up Studies Human |
| Zdroj: | Annals of Surgery. 246:1010-1015 |
| ISSN: | 0003-4932 |
| Popis: | OBJECTIVE: The primary goal of this study was to clarify whether a laparoscopic (LPS) approach could be considered the dominant strategy in patients undergoing right colectomy. SUMMARY BACKGROUND DATA: Because few nonrandomized or small sized studies have been carried out so far, definitive conclusions about the role of LPS right colectomy cannot be drawn. METHODS: Two hundred twenty-six patients, candidates for right colectomy, were randomly assigned to LPS (n = 113) or open (n = 113) resection. The postoperative care protocol was the same for both groups. Trained members of the surgical staff who were not involved in the study registered postoperative morbidity. Follow-up was carried out for 30 days after hospital discharge. The following costs were calculated: surgical instruments, operative room occupation, routine care, postoperative morbidity, and hospitalization. RESULTS: Conversion rate in the LPS group was 2.6% (3 of 113). Operative time (in minutes) was longer in the LPS group (131 vs. 112, P = 0.01). Postoperative morbidity rate was 18.6% in the open group and 13.3% in the LPS group (P = 0.31). Postoperative stay was one day longer in the open group (P = 0.002). No difference was found in postoperative quality of life. The additional operative charge in the LPS group was €980 per patient randomized (€821 for surgical instruments and €159 for longer operative time). The savings in the LPS group was €390 per patient randomized (€144 for shorter length of hospital stay and €246 for the lower cost of postoperative morbidity). The net balance resulted in a €590 extra charge per patient randomly allocated to the LPS group. CONCLUSION: LPS slightly improved postoperative recovery. This translated into a savings that covered only 40% of the extra operative charge. Therefore, open right colectomy could be still considered an effective procedure. |
| Databáze: | OpenAIRE |
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