Elective conventional colectomy in the era of laparoscopic surgery

Laparoscopic surgery, since its introduction into the general surgery, has reduced hospital stay. Can lessons learned from laparoscopic surgery about aggressive postoperative care be applied to elective conventional colectomy? Between August 1994 and February 1995, a prospective study was conducted on 24 consecutive patients undergoing elective conventional colectomy with primary anastomosis. A comparison of 30 consecutive patients in the 7 months immediately before this study were used as a historical control group. Both groups were comparable in age, indications for operation, type of operation, and operative time. The protocol consisted of an outpatient bowel prep, hospital admission on day of surgery, and intravenous metoclopramide starting before the operation and continued every 6 hours with diet started at 24 hours. Patients were discharged on regular diet after a bowel movement and were continued on oral metoclopramide for a total of 7 days. Hospital stay was reduced from 8 days (range 4-19 days) to 4 days (range 2-7 days) on the protocol P < 0.001). Hospital charges were also reduced by 20 per cent (from $18,450 to $14,586) (P = 0.066). Complication rate and postoperative emergency room visits as a measure of quality of care did not differ between the two groups. By implementing this protocol, hospital costs and length of stay for elective conventional colectomy were reduced without compromising patient care.