The economic impact of laparoscopic inguinal hernia repair: results of a double-blinded,prospective, randomized trial

For this study, 66 patients with a preoperative diagnosis of unilateral primary inguinal hernia were randomized to undergo laparoscopic totally extra peritoneal (TEP), laparoscopic transabdominal (TAPP), or open inguinal hernia repair with polypropylene mesh (Lichtenstein type). Both the operative team caring for the patient postoperatively and the patient were blinded to the operative approach by placement of a large dressing covering the abdomen, which was not removed until postoperative day 3. The patients recorded their pain level on a visual analog pain scale daily. Medication usage also was recorded. All patients were seen at 7-day intervals until they returned to work. The patients were interviewed during their postoperative visits by an investigator blinded to the operative approach and questioned regarding their ability to return to work and their pain levels. The average number of lost work days in all the groups was 12, and there was no significant difference between the three groups (p = 0.074). The average operating time for the TAPP procedure was 59 min, less than the time required to complete either the TEP or the Lichtenstein approach, which had equivalent operative times (p = 0.027). The material cost was significantly lower for the Lichtenstein repair ($1,200 less) than for either of the laparoscopic approaches, a saving primarily related to consumable operating room supplies. The TEP repair costs were minimally higher than those for the TAPP repair ($125 more). No significant differences were noted in the postoperative pain scales, and the use of postoperative oral analgesics was equivalent. The higher operative costs noted for the laparoscopic hernia repairs were not offset by a shortened convalescence. Postoperative pain appears to be equivalent regardless of the operative approach chosen and is easily managed with oral analgesics. Presented at the 2003 Society of the American Gastrointestinal and Endoscopic Surgeons (SAGES) Annual Meeting March 12–15, Los Angeles, CA