Farinas L P, Griffen F D
Department of Surgery, Louisiana State University Medical Center, Shreveport 71130, USA.
Surg Endosc. 2000 Jan;14(1):37-40. doi: 10.1007/s004649900007.
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.
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.
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.
Costs can be significantly reduced and quality maintained when performing TEP herniorrhaphy without balloon dissection using nondisposable cannulas.
倾向于采用腹腔镜腹股沟疝修补术的外科医生面临着控制与该技术相关的额外医院成本的压力，因为这种技术并非普遍被认为优于成本较低的开放修补术。本研究的目的是比较使用和不使用球囊分离及一次性套管进行完全腹膜外（TEP）疝修补术的成本和质量。
我们研究了92例TEP患者。前36例患者（第1组）采用球囊分离和一次性套管进行修补。接下来的37例患者（第2组）使用非一次性进入套管进行修补，不进行球囊分离，使用一次性工作端口。最后19例患者（第3组）的修补方式与第2组相同，只是所有套管均为非一次性。
三组患者的人口统计学数据和并发症情况具有可比性。第1组手术的平均每例住院成本为2099美元；第2组为1920美元；第3组为1607美元。患者成本因不同原因而相应降低。我们还回顾了在研究期间接受Lichtenstein修补术的20例患者。这些修补术的平均住院成本为1556美元。该组未与TEP组进行随机分组，选择标准不同；因此，未对比较Lichtenstein修补术和TEP手术的数据进行统计学分析。
在进行TEP疝修补术时，不使用球囊分离并使用非一次性套管可显著降低成本并维持质量。
