[The economics of contralateral laparoscopic inguinal hernia exploration. Cost calculation of herniotomy in infants].
BACKGROUND
Diagnostic laparoscopy (DL) of the contralateral side during inguinal herniotomy via the hernia sack may avoid a subsequent second operation. Can this procedure however also reduce costs in the German health care system?


METHODS
Prospective analysis was performed of children operated on for inguinal hernia (IH) from March 2006 until October 2007. Using a linear mathematic model, the costs for different scenarios were calculated regarding the risk of contralateral IH. We thereby determined the incidence of contralateral IH at which DL became economically reasonable.


RESULTS
A total of 123 unilateral IH operations (IH-OP) were performed in infants during the study period. Of these, 31 patients underwent DL of the contralateral side. Thirteen open hernia sacks were identified and ligated during the same operation. The following costs were calculated: (1) IH-OP without DL, 286 Euro, (2) IH-OP with contralateral DL, 338 Euro, (3) IH-OP with DL and synchronous ligation of the contralateral side, 393 Euro, and (4) metachronous operations of bilateral IH, 572 Euro. The incidence of contralateral hernia described in the literature ranges from 20% to 50%. Linear regression of the relative costs shows an economic advantage for DL with an incidence above 23%.


CONCLUSIONS
Laparoscopic evaluation of the contralateral side in IH-OP is a rational approach for the patient and makes economic sense in the German health care system.
Muensterer
O J
OJ
Department of Pediatric Surgery, Childern's Hospital of Alabama, University of Alabama at Birmingham, 1600 7th Avenue South, ACC 300, 35233, Birmingham, Alabama, USA. oliver.muensterer@ccc.uab.edu
Woller
T
T
Metzger
R
R
Till
H
H
D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D005858:Germany; D006552:Hernia, Inguinal / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007264:Inguinal Canal / Q000601:surgery*; D010535:Laparoscopy / Q000191:economics*; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation / Q000191:economics