Long-term cost-minimization analysis comparing laparoscopic with open (Lichtenstein) inguinal hernia repair

Laparoscopic surgery has emerged as a new treatment modality for inguinal hernia repair. The aim of the present study was to analyse its long-term costs in relation to those of open repair.

A randomized multicentre study comparing totally extraperitoneal laparoscopic repair (TEP) with open repair by the Lichtenstein procedure was performed on men with a primary inguinal hernia. Long-term data on recurrences and complications up to 5 years after operation were collected. Taking treatment costs into consideration, a cost-minimization analysis was conducted.

A total of 1370 patients had an inguinal hernia repair, 665 in the TEP and 705 in the Lichtenstein group. The total hospital cost for the index operation was 710.6 euro higher for TEP repair (P < 0.001). Including costs associated with recurrences and complications, this difference increased to 795.1 euro (P < 0.001). Taking community costs into account, the difference decreased by 503.1 euro to 292.0 euro (P = 0.024).

This cost-minimization analysis, including complications, reoperations and community costs during follow-up of 5 years, showed that laparoscopic inguinal hernia repair had a small but significant increase in overall costs compared with open repair.