Perniceni T, Danès M, Boudet M J, Levard H, Gayet B
Département Médico-Chirurgical de Pathologie Digestive, Institut Mutualiste Montsouris et Université Paris VI.
Gastroenterol Clin Biol. 1998 Dec;22(12):1061-4.
Laparoscopy is more expensive than Shouldice procedure for inguinal hernia repair. The aims of this study were to evaluate the overcost, to look for its causes and to propose a strategy of cost reduction.
One hundred and sixty three unilateral inguinal hernia repairs were performed from January 1995 to June 1996 in our institution, functioning under financial rule of total endowment. Forty five of the 163 procedures were laparoscopic procedures. The mean operative cost of each procedure was calculated from physician, personnel and equipment costs (amortization, consumable products and maintenance).
The mean costs were 2,210 FF and 6,779 FF for Shouldice and laparoscopic procedures, respectively. This overcost of 4,569 FF was reduced to 893 FF by increasing surgeon's experience, which shortened operative duration and ward cost, and by the use of a non specific mesh fastened in place with threads. The mean operative cost of laparoscopy was then 3,103 FF.
A change in surgical practice allows a reduction in the operative overcost of laparoscopic unilateral inguinal hernia repair by 80.4%.
腹腔镜腹股沟疝修补术比肖尔代斯手术费用更高。本研究旨在评估额外费用，寻找其原因并提出降低成本的策略。
1995年1月至1996年6月，在我们实行全额资助财务制度的机构中进行了163例单侧腹股沟疝修补术。163例手术中有45例为腹腔镜手术。根据医生、人员和设备成本（折旧、消耗品和维护）计算每个手术的平均手术成本。
肖尔代斯手术和腹腔镜手术的平均成本分别为2210法郎和6779法郎。通过增加外科医生的经验（这缩短了手术时间和病房成本）以及使用用缝线固定到位的非特异性补片，4569法郎的额外费用降至893法郎。腹腔镜手术的平均手术成本随后为3103法郎。
手术方式的改变可使腹腔镜单侧腹股沟疝修补术的手术额外费用降低80.4%。
