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Laparoscopic contralateral groin exploration: is it cost effective?

Steven L Lee¹, Roman M Sydorak, Stanley T Lau

¹Division of Pediatric Surgery, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, CA 90027, USA. slleemd@yahoo.com

Journal of Pediatric Surgery

|April 14, 2010

Summary

Laparoscopic contralateral groin exploration during unilateral inguinal hernia repair is cost-effective. This minimally invasive approach identifies more cases and prevents future surgeries, saving healthcare costs.

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Area of Science:

Pediatric Surgery
Minimally Invasive Surgery
Health Economics

Background:

Transinguinal laparoscopy is a safe and effective method for contralateral groin evaluation during unilateral inguinal hernia repair (UIHR).
The economic viability of laparoscopic contralateral groin exploration (LCGE) remains a key consideration for surgeons.

Purpose of the Study:

To determine the cost-effectiveness of laparoscopic contralateral groin exploration (LCGE) in pediatric patients undergoing unilateral inguinal hernia repair (UIHR).

Main Methods:

A retrospective review of pediatric patients who underwent UIHR and LCGE between 2006 and 2007.
Cost analysis based on Medicare reimbursement, comparing the expense of LCGE and immediate repair of contralateral patent processus vaginalis (CPPV) against the projected cost of a future contralateral inguinal hernia repair.

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Main Results:

Out of 81 patients, 78 (96.3%) had successful LCGE.
Eight patients (10.3%) were found to have a CPPV and underwent immediate contralateral open repair.
The total cost for LCGE and immediate repairs was $13,080, compared to an estimated $20,440 for future separate operations.

Conclusions:

Laparoscopic contralateral groin exploration at the time of unilateral inguinal hernia repair is a cost-effective strategy.
LCGE can lead to significant cost savings by identifying and treating contralateral patent processus vaginalis during the initial procedure, avoiding a second surgery.