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