Cost-Effectiveness of Laparoscopic and Open Pediatric Inguinal Hernia Repair

Abstract

Aim: Laparoscopic inguinal hernia (IH) repair is an alternative to open surgery. A potential advantage of laparoscopic repair is prevention of contralateral metachronous hernia although some studies report higher recurrence rate. We aim to determine the cost-effectiveness of open versus laparoscopic IH repair taking into account metachronous and recurrence rates. Method: Retrospective single centre study of children (<5 year) undergoing elective open or laparoscopic repair for a unilateral IH between February 2018 -October 2019. Ten cases in each of 4 groups were included (open daycase, open overnight, laparoscopic daycase, laparoscopic overnight).Cases incurring a higher cost due to comorbidities or additional procedure were excluded. Patient level information and costing system (PLICS) data was obtained from the hospital finance. Mean (SD) procedural cost was compared for open and laparoscopic procedures. A financial model was created factoring metachronous and recurrent rates. Results:Cost of open daycase repair was £1866.24 (SD: 311.15) compared to £2210.13 (SD: 391.36) for daycase laparoscopic repair. For overnight repair, cost of open was £2442.82 (SD: 497.05) compared to £2585.35 (SD: 384.66) for laparoscopic. On calculating the cost-effectiveness point using the difference in metachronous and recurrence rate between the two procedures, laparoscopic is more cost-effective than open daycase repair at 18.43%. For overnight repair, the difference rate is 5.84%. Conclusion:Our data suggest that based on metachronous and recurrence rates in the current literature, laparoscopic IH repair is more cost-effective than open repair for cases requiring overnight stay whereas for daycase procedures, open IH repair is more cost-effective.

Green Guidewire Combined with Epidural Needle-Saline Separating Minimize Invasiveness and Optimize Outcomes in Single-Port Laparoscopic Treatment for Pediatric Inguinal Hernia

“…However, the single-port laparoscopic method also has a certain degree of risks or complications. [19][20][21] Such laparoscopic ligation of hernia ring requires relatively high level of the operator skill. [22] Sometimes in single-port method, the instrument needle cannot successfully puncture to the extraperitoneal space and bypass the vas deferens and spermatic cord at one time, and may need repeated punctures, which is easy to cause bleeding, resulting in blurred anatomical structure of the vas deferens and spermatic cord region, thereby increasing the possible injury to vas deferens, spermatic or iliac vessels and leading to complications like extraperitoneal hematoma, testicular atrophy, etc.…”