C. H. Davis1, T. Gaglani2, H. R. Bailey1,2, M. V. Cusick1,2 1Methodist DeBakey Heart And Vascular Center,Department Of Surgery,Houston, TX, USA 2University Of Texas Health Science Center At Houston,Department Of Surgery,Houston, TX, USA
Introduction:
The relapsing and remitting nature of Inflammatory Bowel Disease (IBD) predisposes patients to the development of fibrotic strictures, which must often be managed surgically. Laparoscopy provides the potential for enhanced perioperative care. Previous studies comparing morbidity and trends of open versus laparoscopic resection in IBD have been constrained by length of study and sample size. The aim of this study was to assess the trends of laparoscopic utilization over time and to compare operative outcomes with between open vs. laparoscopic technique.
Methods:
Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, patients with primary diagnosis of IBD undergoing surgical resection from 2005-2015 were identified using a combination of ICD-9 and CPT codes. Utilization as well as morbidity and mortality rates were then compared between open and laparoscopic resections.
Results:
A total of 29,266 resections were performed on IBD patients; 4,856 (16.6%) performed laparoscopically. The mean age in the open and laparoscopic groups was 43.8 and 38.9 years, respectively. The mean BMI in the open and laparoscopic groups was 25.7 and 25.2 kg/m2. The use of laparoscopy increased over time from 5.9% in 2005 to 23.2% in 2015. Comparing laparoscopic versus open, postoperative complication rates favored laparoscopy in each of the 16 categories. (Table 1) The most common complications in both laparoscopic and open methods were organ space infection (5.4% vs. 6.9%), superficial surgical site infection (4.6% vs. 7.1%), and urinary tract infection (1.3% vs. 3.4%). Length of stay was also markedly reduced in the laparoscopic group (6.4 vs. 9.3 days).
Conclusion:
These data indicate that the number of laparoscopic resections for IBD have been increasing over time. Favorable complication rates, operating time and hospital stay suggest that laparoscopy may be a safer option and should be preferred for fibrotic bowel resection. There are various limitations of this study that stem from the use of the NSQIP database. Skill or training level of surgeons and outcome data past 30 postoperative days are not captured. Furthermore, there was limited information about the clinical complexity of each case as the database did not contain inflammatory markers such as C-reactive protein or sedimentation rates. Future analyses should be conducted about the relative efficacy of robotic surgery as well as single incision laparoscopic surgery.
