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Routine pathological evaluation of tissue from inguinal hernias in children is unnecessary
Grant G Miller1, Susan E McDonald, Kris Milbrandt
1Department of Surgery, University of Saskatchewan, Royal University Hospital, Saskatoon, Sask. miller@duke.usask.ca
Insights
Routine pathological evaluation of pediatric inguinal hernia sacs is costly and rarely identifies significant disease. This unnecessary expense should be avoided, reserving evaluation for select cases.
Area of Science:
- Pediatric Surgery
- Pathology
- Health Economics
Background:
- Unexpected disease within pediatric inguinal hernia sacs is infrequent.
- The study addresses the cost-effectiveness of routine pathological evaluations for these sacs.
Purpose of the Study:
- To investigate the cost of routine pathological evaluation of pediatric inguinal hernia sacs.
- To determine the incidence of clinically significant pathological findings in these specimens.
Main Methods:
- Retrospective review of health records for pediatric patients (under 20) undergoing inguinal hernia repair (1988-1997).
- Microscopic evaluation of 456 specimens, with further review of operative reports and histology for specific findings.
- Immunohistochemical staining for muscle-specific actin and cost estimation based on a provincial physician-billing schedule.
Main Results:
- 488 inguinal hernia repairs were performed in 371 pediatric patients during the study period.
- Routine microscopic evaluation was performed on 93.4% of specimens.
- Only 4 cases (0.88%) yielded unexpected findings (epididymis), with an estimated cost of Can$6988 per case.
Conclusions:
- Routine histologic evaluation of pediatric inguinal hernia sacs represents an unnecessary expenditure.
- Pathological evaluation should be reserved for select cases, determined by surgeon discretion.
Introduction:
Because unexpected disease is rare in a child's inguinal hernia sac we decided to investigate the cost of routine pathological evaluation of inguinal hernial sacs in children and the incidence of clinically significant pathological findings.
Methods:
We searched the health records at the University Hospital, Saskatoon, for patients under 20 years of age who had inguinal hernia repair between 1988 and 1997. For records noting pathology findings of duct-like structures, the operative reports and histology slides were reviewed. Specimens were immunostained for muscle-specific actin. The cost of pathological evaluation was estimated using a provincial physician-billing schedule.
Results:
During the study period, there were 488 inguinal hernia repairs in 371 patients under 20 years of age. Of these, 456 (93.4%) specimens were evaluated microscopically. There were 4 (0.88%) cases with unexpected findings diagnosed as epididymis at a cost of Can dollar 6988/case.
Conclusion:
The routine histologic evaluation of inguinal hernia sacs in children is an unnecessary expense and should be reserved for select cases at the discretion of the surgeon.