Abstract
Introduction Laparoscopic colorectal surgery has recently gained widespread acceptance and has been endorsed by the National Institute of Clinical Excellence. However, it is still unclear whether the laparoscopic approach is cost effective when compared to open surgery, and whether there are benefits with this approach. This thesis aims to address both of these issues, evaluating the cost effectiveness of laparoscopic colorectal surgery, and investigating whether there are short-term benefits in terms of an improved quality of life for patients, and long-term benefits by reducing the formation of adhesions. Patients and Methods Two studies were performed at The Royal Surrey County Hospital. The first was a prospective cohort study evaluating the cost effectiveness of laparoscopic and open colorectal surgery. The resources used and the direct healthcare costs of the surgical procedures were calculated. The health related quality of life (HRQoL) was assessed using the SF-36 and EQ-5D instruments during the patients recovery from the operation over a 6 week period. The cost and QoL elements were used to perform a cost effectiveness analysis. The second study focused on adhesion formation following laparoscopic and open colorectal surgery, by evaluating their formation at a "second-look" operative procedure. Results 200 consecutive patients were recruited to the cost effectiveness study, with HRQoL data available on 169 patients, and cost data on 200 patients. HRQoL was improved in those patients who had laparoscopic surgery (p<0.05). Operative costs were greater and the hospital costs less in the laparoscopic group (p<0.001). The overall costs were equivalent (£3847 v £4382, p=0.286). The economic analyses demonstrated that the laparoscopic approach is cost effective (QALY gain 0.014). 46 patients were recruited to the adhesion study; there were significantly fewer adhesions in patients who had previously had laparoscopic as opposed to open colorectal surgery (p<0.001). Conclusions Laparoscopic colorectal surgery is likely to result in an improved quality of life for patients during their recovery, is cost neutral when compared to equivalent open surgery, and is probably cost effective. Laparoscopic colorectal surgery causes the formation of fewer adhesions than open surgery. The results of our study require verification within a randomised controlled trial.