[Laparoscopy versus the Shouldice intervention in the treatment of unilateral inguinal hernia: can the operative surcosts be minimized?].
OBJECTIVE
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.


METHODS
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).


RESULTS
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.


CONCLUSIONS
A change in surgical practice allows a reduction in the operative overcost of laparoscopic unilateral inguinal hernia repair by 80.4%.
Département Médico-Chirurgical de Pathologie Digestive, Institut Mutualiste Montsouris et Université Paris VI.
T
T
Perniceni
M
M
Danès
M J
MJ
Boudet
H
H
Levard
B
B
Gayet
D002983:Clinical Competence / Q000592:standards; D003363:Cost Control; D006302:Health Services Research; D006552:Hernia, Inguinal / Q000601:surgery*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D007813:Laparotomy / Q000191:economics* / Q000379:methods; D010297:Paris; D013526:Surgical Mesh / Q000191:economics; D013997:Time Factors