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Adhesions are Common and Costly after Open Pouch Surgery

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Journal of Gastrointestinal Surgery

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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Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, John Radcliffe Hospital, University of Oxford, Oxford, UK

    Pierpaolo Sileri, Roberto Sthory, Chris Cunningham, Neil J. Mortensen & Ian Lindsey

  2. Department of Gynaecology, Oxford Fertility Unit, Women’s Center, John Radcliffe Hospital, University of Oxford, Oxford, UK

    Enda McVeigh & Tim Child

  3. Department of Colorectal Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK

    Ian Lindsey

Authors
  1. Pierpaolo Sileri
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  2. Roberto Sthory
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Correspondence to Ian Lindsey.

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Sileri, P., Sthory, R., McVeigh, E. et al. Adhesions are Common and Costly after Open Pouch Surgery. J Gastrointest Surg 12, 1239–1245 (2008). https://doi.org/10.1007/s11605-008-0481-3

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  • DOI: https://doi.org/10.1007/s11605-008-0481-3

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