Smink Douglas S, Paquette Ian M, Finlayson Samuel R G
Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
J Laparoendosc Adv Surg Tech A. 2009 Dec;19(6):745-8. doi: 10.1089/lap.2009.0183.
Laparoscopic inguinal hernia repair is a safe, effective treatment for inguinal hernias and is considered, by some, to be the procedure of choice for recurrent inguinal hernias. Little is known, however, about the frequency with which laparoscopic inguinal hernia repair is performed and the determinants of its utilization.
We performed a retrospective cohort study of all patients undergoing outpatient inguinal hernia repairs in Florida in 2002 and 2003, using the AHRQ State Ambulatory Surgery Database. We compared patient demographics, indication for procedure, location of procedure (i.e., hospital or ambulatory surgery center), and charges for laparoscopic and open repairs.
Of 58,172 outpatient inguinal hernia repairs, 11,351 (19.5%) were performed laparoscopically. In the subset of 6221 recurrent inguinal hernias, only 1276 (20.5%) were performed laparoscopically. Patients undergoing a laparoscopic repair were younger (52.7 versus 57.4 years; P < 0.001), more likely to be of the white race (84.4 vs. 79.3%; P < 0.001), and more likely to have private insurance (62.0 versus 47.2%; P < 0.001), compared to those undergoing open repair. Laparoscopic repairs resulted in higher charges than open repairs ($12,087 versus $7,580; P < 0.001). Laparoscopic repairs were less commonly performed at ambulatory surgery centers (ASCs) than at hospitals (13.7 versus 20.9%; P < 0.001), although ASCs had significantly lower charges for laparoscopic hernia repairs than did hospitals ($6,973 versus $12,860; P < 0.001).
The laparoscopic approach is used in only a small fraction of initial and recurrent inguinal hernia repairs and is used more commonly at hospitals than at ASCs. Although clinical indications play a role, the use of laparoscopy for inguinal hernia repair may also be influenced by financial considerations.
腹腔镜腹股沟疝修补术是治疗腹股沟疝的一种安全、有效的方法，并且被一些人认为是复发性腹股沟疝的首选术式。然而，关于腹腔镜腹股沟疝修补术的实施频率及其使用的决定因素，人们知之甚少。
我们使用美国医疗保健研究与质量局（AHRQ）的州门诊手术数据库，对2002年和2003年在佛罗里达州接受门诊腹股沟疝修补术的所有患者进行了一项回顾性队列研究。我们比较了患者的人口统计学特征、手术指征、手术地点（即医院或门诊手术中心）以及腹腔镜修补术和开放修补术的费用。
在58172例门诊腹股沟疝修补术中，11351例（19.5%）采用了腹腔镜手术。在6221例复发性腹股沟疝患者亚组中，仅1276例（20.5%）采用了腹腔镜手术。与接受开放修补术的患者相比，接受腹腔镜修补术的患者更年轻（52.7岁对57.4岁；P<0.001），更可能是白人（84.4%对79.3%；P<0.001），更可能拥有私人保险（62.0%对47.2%；P<0.001）。腹腔镜修补术的费用高于开放修补术（12087美元对7580美元；P<0.001）。腹腔镜修补术在门诊手术中心（ASC）的实施频率低于医院（13.7%对20.9%；P<0.001），尽管ASC的腹腔镜疝修补术费用明显低于医院（6973美元对12860美元；P<0.001）。
腹腔镜手术方法仅用于一小部分初次和复发性腹股沟疝修补术，且在医院比在门诊手术中心更常用。虽然临床指征起一定作用，但腹腔镜腹股沟疝修补术的使用也可能受到经济因素的影响。
