Day case laparoscopic rectopexy is feasible, safe, and cost effective for selected patients.

BACKGROUND: With the ever-present financial and bed pressures in the UK health care system, there is a drive toward increasing day surgery provision. Laparoscopic minimally invasive surgery lends itself well to the day case setting. This study aimed to show that day case laparoscopic rectopexy (DCLR) is safe, produces a good clinical outcome, and is cost effective for selected well-motivated patients. METHODS: Since 2001, 28 patients have undergone procedures for rectal prolapse at the authors' institution. Of 12 laparoscopic rectopexy patients, 5 were selected for DCLR on the basis of home circumstances, general fitness, and patient wishes. Patient satisfaction with DCLR was assessed by telephone questionnaire. A retrospective analysis of case notes was performed to compare complications, analgesia requirements, and length of hospital stay. In-hospital costs for all rectal prolapse procedures were calculated. RESULTS: The DCLR group consisted of generally younger and fitter patients. One patient in the DCLR group had persistent abdominal pain and diarrhea requiring an emergency visit. Four of the five patients in the DCLR group were available for telephone interview. Three had stopped analgesia by the third day, reporting their experience as excellent or good. They had no hesitation recommending the procedure for day case usage. Whereas Delorme's procedure and inpatient laparoscopic rectopexy cost much the same, there is a clear cost benefit with DCLR for selected patients of approximately pound1,000 ($1,962) per patient. CONCLUSION: Day case laparoscopic rectopexy has never been reported previously. It is safe, feasible, and acceptable for selected well-motivated patients. Compared with Delorme's procedure and inpatient laparoscopic rectopexy, savings of pound1,000 per patient can be achieved because of an average 3-day decrease in bed occupancy.

Robot-assisted vs. conventional laparoscopic rectopexy for rectal prolapse: a comparative study on costs and time.

PURPOSE: Laparoscopic rectopexy has become one of the most advocated treatments for full-thickness rectal prolapse, offering good functional results compared with open surgery and resulting in less postoperative pain and faster convalescence. However, laparoscopic rectopexy can be technically demanding. Once having mastered dexterity, with robotic assistance, laparoscopic rectopexy can be performed faster. Moreover, it shortens the learning curve in simple laparoscopic tasks. This may lead to faster and safer laparoscopic surgery. Robot-assisted rectopexy has been proven safe and feasible; however, until now, no study has been performed comparing costs and time consumption in conventional laparoscopic rectopexy vs. robot-assisted rectopexy. METHODS: Our first 14 cases of robot-assisted laparoscopic rectopexy were reviewed and compared with 19 patients who underwent conventional laparoscopic rectopexy in the same period. RESULTS: Robot-assisted laparoscopic rectopexy did not show more complications. However, the average operating time was 39 minutes longer, and costs were euro 557.29 (or: dollars 745.09) higher. CONCLUSION: Robot-assisted laparoscopic rectopexy is a safe and feasible procedure but results in increased time and higher costs than conventional laparoscopy.

Economic impact of laparoscopic versus open abdominal rectopexy.

BACKGROUND: The introduction of new laparoscopic techniques has important cost implications. The aim of this study was to compare the cost effectiveness of laparoscopic rectopexy with that of open abdominal rectopexy for full-thickness rectal prolapse. METHODS: A cost effectiveness study was conducted alongside a randomized trial of laparoscopic versus open abdominal rectopexy. RESULTS: The efficacy trial demonstrated significant subjective and objective differences in favour of the laparoscopic technique. The mean operating time was 51 min longer for laparoscopic rectopexy than for the open procedure. Laparoscopic disposables incurred a mean cost of pound 291 per patient. The mean duration of hospital stay was significantly shorter for the laparoscopic group (P = 0.001). Laparoscopic rectopexy was associated with an overall mean cost saving of pound 357 (95 per cent confidence interval pound 164 to pound 592; P = 0.042) per patient. CONCLUSION: Laparoscopic rectopexy is associated with superior clinical outcomes and is cheaper than the open approach.

Laparotomic vs. laparoscopic rectopexy in complete rectal prolapse.

AIM: The aim of this study was to compare the functional and clinical results of laparotomic and laparoscopic rectopexy in 2 homogeneous groups of patients with complete rectal prolapse and fecal incontinence. METHODS: Between January 1989 and December 1997, twenty-three patients underwent abdominal rectopexy. Thirteen patients (group A, 12 females and 1 male, mean age 57.3, range 22-76 years), and 10 patients (group B, 10 females, mean age 52.3, range 26-70 years) were submitted respectively to either Wells laparotomic or laparoscopic rectopexy by the same surgical team using the same surgical technique and materials. Before the operation a detailed clinical history was collected, and the patients were studied by inspection and digital examination of the anorectum, proctosigmoidoscopy, pancolonic transit time, dynamic defecography, anorectal manometry and anal electromyography. After the operation all patients underwent perineal physiotherapy, external electric stimulation, and perineal biofeedback. Mean follow-up was 37.1 (range 6-90) months in group A and 25.7 (range 6-49) months in group B. Values were compared by chi(2), Mann-Whitney U, and Wilcoxon tests as appropriate. Differences were considered significant at p < 0.05. RESULTS: In both groups dyschezia and fecal incontinence improved significantly (p < 0.05) after the operation. The basal pressure of the anal sphincter, squeezing pressure and rectoanal reflex improved without significance, and anal-perineal pain was not significantly reduced. In group B the postoperative hospital stay was lower than in group A, with a reduction in costs. CONCLUSION: Laparoscopic Wells rectopexy has the same clinical and functional results as laparotomic rectopexy, but with a shorter postoperative hospital stay and lower costs.

Rates of diseases and their associated costs in two Colorado sheep feedlots (1985-1986).

Data related to rates of disease and their associated costs were collected for 12 months from 2 sheep feedlots in northern Colorado. There was an apparent seasonal occurrence of many of the diseases. Pneumonia, enterotoxemia, acidosis, and transport tetany accounted for most of the diseases seen in these feedlots and were responsible for most of the economic losses. There was a large difference in the incidence of diseases between the 2 feedlots and in the expenditures for disease prevention between the 2 feedlots.