Hospital Costs Associated With Laparoscopic and Open Inguinal Herniorrhaphy

Purpose:

The purpose of this study was to compare the total hospital costs associated with elective laparoscopic and open inguinal herniorrhaphy.

Methods:

A prospectively maintained database was used to identify patients who underwent elective inguinal herniorrhaphy from April 2009 to March 2011. A retrospective review of electronic patient records was performed along with a standardized case-costing analysis using data from the Ontario Case Costing Initiative. The main outcomes were operating room (OR) and total hospital costs.

Results:

Two hundred eleven patients underwent elective unilateral inguinal herniorrhaphy (117 open and 94 laparoscopic), and 33 patients underwent elective bilateral inguinal herniorrhaphy (9 open and 24 laparoscopic). OR and total hospital costs for open unilateral inguinal hernia repair were significantly lower than for the laparoscopic approach (median total cost, $3207.15 vs $3723.66; P < .001). OR and total hospital costs for repair of elective bilateral inguinal hernias were similar between the open and laparoscopic approaches (median total cost, $4574.02 vs $4662.89; P = .827).

Conclusions:

In the setting of a Canadian academic hospital, when considering the repair of an elective unilateral inguinal hernia, the OR and total hospital costs of open surgery were significantly lower than for the laparoscopic techniques. There was no statistical difference between OR and total hospital costs when comparing open surgery and laparoscopic techniques for the repair of bilateral inguinal hernias. Given the perioperative benefits of laparoscopy, further studies incorporating hernia-specific outcomes are necessary to determine the cost-effectiveness of each approach and to define the optimal treatment strategy.     

快速康复护理路径在老年无张力疝修补术患者围术期的应用效果

目的：探讨快速康复护理在老年无张力疝修补术患者围术期的应用效果。方法选取本院2012年5月~2014年5月收治的120例老年无张力疝修补术患者作为研究对象,随机分为对照组与观察组,各60例。对照组给予围术期常规护理,观察组给予快速康复护理。比较两组的术后并发症发生率,记录两组的手术一般情况及住院费用、住院时间等指标。结果观察组的尿潴留、腹胀、肺部感染发生率显著低于对照组,差异有统计学意义(P<0.05)。观察组的下床活动时间、肠胃功能恢复时间、住院时间显著短于对照组,差异有统计学意义(P<0.05)。观察组的住院费用显著低于对照组,差异有统计学意义(P<0.05)。结论快速康复护理在老年无张力疝修补术患者围术期的应用效果显著,能够降低术后并发症发生率,缩短术后康复时间,值得临床推广应用。     

Lichtenstein法无张力疝修补术治疗120例成人腹股沟疝体会

目的总结Lichtenstein法治疗成人腹股沟疝的疗效。方法120例腹股沟疝患者,采用Lichtenstein法行无张力疝修补术,其中斜疝93例（包括复发性斜疝14例,双侧斜疝3例）;直疝27例。结果120例患者手术过程顺利,手术时间平均50（45-60）min,术后住院5-7 d。伤口感染1例,经抗生素治疗及局部换药痊愈;阴囊积液4例,经阴囊穿刺1-2次治愈;局部疼痛2例,术后1-3月逐渐好转。术后96例获随访,平均14个月,无一例复发。结论Lichtenstein法治疗成人腹股沟疝效果确切,符合解剖生理特点,操作简单,术后并发症少,值得推广。     

腹腔镜腹腔内网片植入治疗腹股沟疝

目的：探讨联合经腹腹膜前腹腔镜疝修补术（transabdominal pre-peritoneal prosthetic,TAPP）、腹腔内网片植入术（intraperitoneal onlaymesh,IPOM）的腹腔镜疝修补法的安全性和可行性。方法：回顾分析30例联合应用TAPP、IPOM患者的临床资料。结果：30例患者手术均获成功,手术时间单侧30～40min,双侧50～60min,术中出血1～5mL术后第2d可下床活动,术后3～4d出院,术后2周均恢复工作,术后随访无粘连肠梗阻,无不良反应。结论：联合TAPP和IPOM后,更能体现微创的原则,易掌握,损伤少,手术时间短,恢复快,费用低,易被患者接受。     

Outcomes of laparoscopic incisional hernia repair: A prospective evaluation

Objective: Although laparoscopic incisional hernioplasty has been gaining in popularity, the best approach for the repair of incisional hernia remains controversial. The present study was undertaken to evaluate the medium‐term outcomes of laparoscopic incisional hernioplasties utilizing onlay GORE‐TEX DualMesh (GORE‐TEX DualMesh Biomaterial; W.L. Gore and Associates, Flagstaff, Arizona, TX, USA). Methodology: Between June 2000 and July 2004, 42 patients underwent laparoscopic incisional hernioplasties at our institution. Perioperative data and postoperative outcomes were collected prospectively and analyzed. Results: Laparoscopic incisional hernioplasty was successfully performed on 39 (93%) patients. Conversion to open repair was required in three patients. The overall mean operative time was 108 min. Sixteen patients (37%) were found to have more than one hernial defect after reduction of the hernial contents. Postoperative morbidity included seroma (n = 8), urinary retention (n = 3), ileus (n = 1), pneumonia (n = 1), fever (n = 1), wound infection (n = 1), and prolonged suture site pain (n = 1) in 13 patients. All these morbidities resolved spontaneously without intervention. Two‐thirds of the patients were discharged within 2 days after surgery. With a median follow up of 2 years, two clinical recurrences (4.8%) were detected. Conclusion: Laparoscopic approach was a safe and efficacious technique for the repair of incisional hernia. Medium‐term outcomes were promising with low postoperative morbidity and recurrence rates. This technique allows clear identification of multiple hernial defects and confers the advantages of minimal access surgery.     

开放式与腹腔镜全腹膜外疝修补术的对照研究

目的比较开放式和腹腔镜全腹膜外疝修补术（TEP）的临床效果。方法回顾性分析2012年1月至2013年7月期间我科收治的148例成人腹股沟疝或股疝的临床资料,根据手术方式的不同分为2组,74例行开放式TEP术（开放式TEP组）,74例行腹腔镜TEP术（腹腔镜TEP组）。结果 2组患者均顺利完成手术。开放式TEP组手术时间为（50.65±30.98）min,术中出血量为（14.97±6.70）m L,术后排气时间为（19.73±3.64）h,住院时间为（6.34±3.80）d,住院费用为（6 361±1 330）元;腹腔镜TEP组手术时间为（70.51±30.07）min,术中出血量为（17.39±4.84）m L,术后排气时间为（19.19±3.65）h,住院时间为（5.35±2.49）d,住院费用为（8 532±777）元。与腹腔镜TEP组相比,开放式TEP组手术时间短,术中出血量少,住院费用低,差异均有统计学意义（P〈0.05）;而术后排气时间和住院时间2组间比较差异无统计学意义（P〉0.05）。开放式TEP组和腹腔镜TEP组术后并发症发生率（8.11%比4.05%）比较差异无统计学意义（P〉0.05）。2组患者随访3~19个月,均无复发病例。结论开放式TEP与腹腔镜TEP的复发率相当,开放式TEP操作相对容易,手术时间短,术中出血量少,且无需腹腔镜设备,住院费用低,适合在基层医院开展。     

Characteristics of laparoscopic inguinal hernia recurrences

Purpose  This is so far the largest series of recurrences after laparoscopic inguinal hernia repair. Methods   Video documents of 1,071 laparoscopic inguinal hernia repairs were retrospectively studied with respect to the affected side, anatomical appearance, gender, history and time interval between operation and recurrence. Only indirect, clinically manifest hernias were included. Results  Recurrences occurred in 32 children (3%), 26 boys and 6 girls, aged 62 days to 14 years (median 3). The right side was affected in 21 children, the left in 10 and a bilateral recurrence was noted in 1 child. A total of 25 recurrences occurred medially to the previous suture and 7 laterally. The knot became loose in three cases. An experienced surgeon had only half the recurrences of a less experienced surgeon. The median time interval between surgery and recurrence was 3.8 months. Children up to the age of 2 years had the highest risk of recurrence. The right/left incidence of recurrences roughly was in proportion to the statistical incidence of hernias. Conclusions  Boys had more recurrences than girls. Most recurrences occur medially. The more experienced the surgeon was, the fewer recurrences he had. The stitches at the medial aspect of the hernia, close to the vas, seem to be the most crucial ones.     

改良佛格逊氏疝修补术的临床应用研究

目的:探讨改良佛格逊氏疝修补术的临床应用价值。方法:97例病人分两组,试验组采用佛格逊氏改良术式;对照组采用网片修补法。分别对两组术中出血量,手术时间,术后疼痛,住院费用,复发率进行比较。结果:实验组术中出血量(15.47±3.52)mL,对照组(30±4.19mL),两组比较有显著性差异(P<0.05);实验组手术时间(44.32±4.27)min,对照组(105.32±3.18)min,两组比较有显著性差异(P<0.05);实验组术后疼痛率为5.09%,对照组为4.65%,两组比较无显著差异(P>0.05);实验组术后复发1例,对照组术后复发1例,两组比较无显著性差异(P>0.05);实验组住院费用平均890元,对照组平均费用1690元,实验组明显低于对照组。结论:改良佛格逊氏疝修补术,术中出血少,操作简单,损伤轻,手术时间短,住院费用低,疗效确切,可以作为基层医院治疗腹股沟疝的手术方法。     

Cost containment and totally extraperitoneal laparoscopic herniorrhaphy

Background: Surgeons who favor the laparoscopic repair of groin hernias are under pressure to contain the additional hospital costs associated with this technique, which is not universally acknowledged to be superior to less expensive open repairs. The purpose of this study was to compare costs and quality for TEP (total extraperitoneal) herniorrhaphy performed with and without balloon dissection and disposable cannulas. Methods: We studied 92 TEP patients. The first 36 patients (group 1) were repaired using balloon dissection and disposable cannulas. The next 37 patients (group 2) were repaired with nondisposable access cannulas, without balloon dissection and with disposable working ports. The final 19 patients (group 3) were repaired just as in group 2 except that all cannulas were nondisposable. Results: The demographic data and complications were comparable for all three groups. The average hospital cost per case for group 1 procedures was $2,099; for group 2, it was $1,920; and for group 3, it was $1,607. Costs for patients decreased comparably but for different reasons. Also reviewed were 20 patients who underwent Lichtenstein repairs during the study period. The average hospital cost for these repairs was $1,556. This group was not randomized with TEP groups, and the selection criteria were different; hence, data comparing the Lichtenstein and TEP procedures were not analyzed statistically. Conclusion: Costs can be significantly reduced and quality maintained when performing TEP herniorrhaphy without balloon dissection using nondisposable cannulas. Received: 26 February 1999/Accepted: 22 March 1999