Surgical outcome and hospital cost analyses of laparoscopic and open tension-free hernia repair |
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Authors: | E Papachristou M Mitselou N Finokaliotis |
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Institution: | (1) Demokratias 41, 15452 P. Psychiko, Athens, Greece,;(2) Argirokastrou 26, 15235 Vrilissia, Athens, Greece,;(3) Troias 23, 15127 Melissia, Athens, Greece, |
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Abstract: | Abstract
Surgeons who favor the laparoscopic repair of groin hernias must limit the additional costs associated with this technique,
which is not universally acknowledged to be superior to other less expensive open tension-free repairs. This retrospective
study compared outcome and costs between laparoscopic and open tension-free hernia repair in 320 patients with inguinal hernias.
Patients underwent either (a) transabdominal preperitoneal procedure (TAPP; 60 patients, 72 procedures), (b) totally extraperitoneal
procedure (TEP; 174 patients, 202 procedures), or (c) open tension-free procedure (86 patients, 105 procedures). Regarding
important postoperative complications there were two (3.3%) recurrences in the TAPP group and one (0.6%) in the TEP group,
and six (9.9%) transient neuralgias in the TAPP group and one (1.2%) in the tension-free group. There were no deaths, no testicular
atrophies, and no wound or mesh infections. The mean hospital postoperative stay was the same in the three groups (1 day).
Mean operating time was shorter in the tension-free group concerning the unilateral cases and shorter in the TEP group concerning
the bilateral cases. Fewer patients required analgesia during the first 6 h after the operative procedure in the TEP group
than in the other two groups. The mean total costs were 483.90 euros in the open tension-free repair, 763.20 euros in the
TAPP repair, and 572.50 euros in the TEP repair. The open procedure was the cheaper for the hospital. Laparoscopic hernia
repair and tension-free repair as described by Gilbert are comparable in postoperative complications. TEP hernia repair is
associated with less postoperative pain and earlier return to normal activities, but it is more expensive and continues to
be a difficult procedure. Open tension-free repair is the least expensive method and is easier to learn than the other two
procedures.
Electronic Publication |
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Keywords: | Inguinal hernia Laparoscopic hernioplasty Totally extraperitoneal approach Laparoscopy Mesh |
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