Open and Laparoscopic Inguinal Hernia Surgery: A Cost Analysis

Mongelli, Francesco; Vajana, Antonjacopo Ferrario di Tor; FitzGerald, Maurice; Cafarotti, Stefano; Lucchelli, Massimo; Proietti, Francesco; Giuseppe, Matteo Di; Regina, Davide La

doi:10.1089/lap.2018.0805

Cited by 19 publications

(21 citation statements)

References 17 publications

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“…Briefly, TEP repair ( i.e ., endoscopic approach) causes less pain, is associated with fewer intraperitoneal complications, and is technically less difficult[ 2 ]. TAPP repair ( i.e ., laparoscopic approach) offers a better view of the anatomy and similar laparoscopic equipment across manufacturers, but it is more costly[ 2 , 58 ].…”

Section: Comparison Of Tapp and Tep Repairsmentioning

confidence: 99%

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Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults

Yasukawa

Aisu

Hori

2020

WJGS

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Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of “tension-free repair” is generally accepted, and surgical repairs with mesh are categorized as “hernioplasties”. Surgeons should have good knowledge of the relevant anatomy. Physicians generally focus on the preperitoneal space, myopectineal orifice, topographic nerves, and regional vessels. Currently, laparoscopic surgery has therapeutic potential in the surgical setting for hernioplasty, with laparoscopic transabdominal preperitoneal (TAPP) repair appearing to be a powerful tool for use in adult hernia patients. TAPP offers the advantages of accurate diagnoses, repair of bilateral and recurrent hernias, less postoperative pain, early recovery allowing work and activities, tension-free repair of the preperitoneal (posterior) space, ability to cover obturator hernias, and avoidance of potential injury to the spermatic cord. The disadvantages of TAPP are the need for general anesthesia, adhering to a learning curve, higher cost, unexpected complications related to abdominal organs, adhesion to the mesh, unexpected injuries to vessels, prolonged operative time, and as-yet-unknown long-term outcomes. Both technical skill and anatomical familiarity are important for safe, reliable surgery. With increasing awareness of the importance of anatomy during TAPP repair, we address the skills and pitfalls during laparoscopic TAPP repair in adult patients using illustrations and schemas. We also address debatable points on this subject.

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Section: Comparison Of Tapp and Tep Repairsmentioning

confidence: 99%

“…Conventional repairs without general anesthesia have lower compensation, so only TAPP and TEP repairs offer hospital revenue in Japan. Although TAPP and TEP repairs are more expensive than conventional repairs[ 2 , 58 ], the cost-effectiveness of the TAPP repair has been documented in other countries[ 100 , 101 ].…”

Section: Cost-effectivenessmentioning

confidence: 99%

Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults

Yasukawa

Aisu

Hori

2020

WJGS

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“…Although TAPP and totally extraperitoneal repairs have a higher cost than conventional repair[ 4 , 195 ], the cost-effectiveness of TAPP repair has been documented in other medically advanced countries ( e.g. , nations in Europe, as well as the United States and Japan)[ 196 , 197 ].…”

Section: Perspective For the Futurementioning

confidence: 99%

Fascinating history of groin hernias: Comprehensive recognition of anatomy, classic considerations for herniorrhaphy, and current controversies in hernioplasty

Hori¹,

Yasukawa²

2021

WJM

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Groin hernias include indirect inguinal, direct inguinal, femoral, obturator, and supravesical hernias. Here, we summarize historical turning points, anatomical recognition and surgical repairs. Groin hernias have a fascinating history in the fields of anatomy and surgery. The concept of tension-free repair is generally accepted among clinicians. Surgical repair with mesh is categorized as hernioplasty, while classic repair without mesh is considered herniorrhaphy. Although various surgical approaches have been developed, the surgical technique should be carefully chosen for each patient. Regarding as interesting history, crucial anatomy and important surgeries in the field of groin hernia, we here summarized them in detail, respectively. Points of debate are also reviewed; important points are shown using illustrations and schemas. We hope this systematic review is surgical guide for general surgeons including residents. Both a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.

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“…Since January 1st 2012, all hospitals in Switzerland have adopted diagnosis-related group (DRG) as reimbursement system (Swiss-DRG) for inpatient treatment. 15,16 The DRG-based reimbursement for a given patient accounts for a severity score (cost-weight) and a fixed reimbursement according to the length of stay. 17 Unlike outpatient treatments, the hospital reimbursement is regulated by the tariff system for outpatient medical services (TARMED), 18 a nationwide, uniform tariff structure with respect to fee-for-service tariffs.…”

Section: Cost Calculation and Modelingmentioning

confidence: 99%

Ultrasound-Guided Pudendal Nerve Block in Patients Undergoing Open Hemorrhoidectomy: A Post-Hoc Cost-Effectiveness Analysis from a Double-Blind Randomized Controlled Trial

Mongelli¹,

Lucchelli²,

Regina³

et al. 2021

CEOR

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Background Pudendal nerve block (PNB) has been demonstrated to reduce postoperative pain and re-admission rates after open hemorrhoidectomy and may reduce costs but, to date, no study has reported data on this aspect. The aim of our study was to perform a cost analysis on PNB use in in- and outpatients undergoing open hemorrhoidectomy. Methods From January 2018 to December 2019, patients undergoing open hemorrhoidectomy were included and randomized to undergo spinal anesthesia either with or without the PNB. Clinical data, direct and indirect costs for in- and outpatients, operating time and operating theatre occupancy were recorded. A cost-effectiveness analysis based on the diagnosis-related groups (DRG) and TARMED reimbursement systems was performed. Results Patients who underwent PNB in addition to spinal anesthesia had significantly less pain and a shorter length of hospital stay after open hemorrhoidectomy. The cost analysis included all 49 patients, 23 of whom, in addition to spinal anesthesia, received a PNB. There were no significant differences in operating theatre occupancy (p=0.662), mean operative time (p=0.610) or time required for anesthesia (p=0.124). Direct costs were comparable (482±386 vs 613±543 EUR, p=0.108), while indirect costs were significantly lower in the PNB group (2606±816 vs 2769±1506 EUR, p=0.005). We estimated an incremental cost-effectiveness ratio (ICER) of −243 ± 881 EUR/pain unit on the VAS. Conclusion Despite limitations, the ultrasound-guided PNB seems to reduce costs in patient undergoing open hemorrhoidectomy under spinal anesthesia. It was shown to be clinically beneficial and cost-effective, and therefore recommendable in patients undergoing open hemorrhoidectomy.

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Open and Laparoscopic Inguinal Hernia Surgery: A Cost Analysis

Cited by 19 publications

References 17 publications

Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults

Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults

Fascinating history of groin hernias: Comprehensive recognition of anatomy, classic considerations for herniorrhaphy, and current controversies in hernioplasty

Ultrasound-Guided Pudendal Nerve Block in Patients Undergoing Open Hemorrhoidectomy: A Post-Hoc Cost-Effectiveness Analysis from a Double-Blind Randomized Controlled Trial

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