title: [Future of endoscopic surgery--German health law and minimal access surgery in an university hospital].
abstract: The future development of endoscopic surgery depends on a medical and economical benefit. Medical advantages are demonstrated under professional conditions of practice in a retrospective study: endoscopical repair of the groin (TEP n = 44) vs. conventional Shouldice- (n = 17) and Lichtenstein (n = 19) method, laparoscopical hemifundoplication (n = 7) vs. traditional Nissen-Rosetti procedure (n = 3) and also resection of the sigmoid (lap. n = 26) vs. open surgery (n = 12). The overall hospital stay is shortend dramatically (primary hernia of the groin 8.8 (Shouldice) and 7.4 (Lichtenstein) vs. 3.1 days (TEP); (hemi-) fundoplication 11.1 (open) vs. 5.0 days (lap.); resection of sigmoid 19.0 (open) vs.17.0 days (lap.)) At the same time quality of care is held or improved. Comparison of real cost analysis revealed a better economical result (593-970 DM lower cost for TEP, 1.256 DM lower costs for lap. hemifundoplication, and 1.918 DM in case of lap. resection of sigmoid) for minimal-access-surgery (MAS), although particular costs for the endoscopic surgical procedure are increasing up to 100%, especially at the beginning (learning curve). The German payment-system does not regard the special conditions of MAS. There is no case-related payment for MAS due to the lower overall costs. Therefore the financial result is worse than for conventional treatment.
authors.affiliation: Chirurgische Klinik der Med. Universität zu Lübeck.
authors.forename: C G
authors.initials: CG
authors.lastname: Bürk
authors.forename: H
authors.initials: H
authors.lastname: Shekarriz
authors.forename: S J
authors.initials: SJ
authors.lastname: Pöppl
authors.forename: W D
authors.initials: WD
authors.lastname: von Detmering
authors.forename: H P
authors.initials: HP
authors.lastname: Bruch
mesh_terms: D000328:Adult; D000368:Aged; D017046:Cost Savings / Q000639:trends; D005260:Female; D005544:Forecasting; D005858:Germany; D015276:Health Care Rationing / Q000191:economics / Q000331:legislation & jurisprudence / Q000639:trends; D006785:Hospitals, University / Q000191:economics / Q000331:legislation & jurisprudence* / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000331:legislation & jurisprudence / Q000639:trends; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000331:legislation & jurisprudence* / Q000639:trends*; D009313:National Health Programs / Q000191:economics / Q000331:legislation & jurisprudence* / Q000639:trends*; D012189:Retrospective Studies; D020535:Video-Assisted Surgery / Q000191:economics / Q000331:legislation & jurisprudence* / Q000639:trends*