Adhesions are Common and Costly after Open Pouch Surgery

• Published in: Journal of gastrointestinal surgery Vol. 12; no. 7; pp. 1239 - 1245
• Main Authors: Sileri, Pierpaolo, Sthory, Roberto, McVeigh, Enda, Child, Tim, Cunningham, Chris, Mortensen, Neil J., Lindsey, Ian
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.07.2008; Springer Nature B.V
• Subjects: Adult; Colonic Diseases - surgery; Colonic Pouches - pathology; Cost-Benefit Analysis; Female; Follow-Up Studies; Gastroenterology; Humans; Ileal Diseases - epidemiology; Ileal Diseases - etiology; Ileal Diseases - prevention & control; Incidence; Intestinal Obstruction - epidemiology; Intestinal Obstruction - etiology; Intestinal Obstruction - prevention & control; Laparoscopy - economics; Laparoscopy - methods; Male; Medicine; Medicine & Public Health; Original Article; Postoperative Complications; Prognosis; Prospective Studies; Surgery; Tissue Adhesions - economics; Tissue Adhesions - epidemiology; Tissue Adhesions - prevention & control; United Kingdom - epidemiology; Small-bowel obstruction; Laparoscopy; Adhesions; Ileal pouch surgery; Ulcerative colitis
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-008-0481-3

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.