Related Experiment Video
Updated: Dec 25, 2025
Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
Review of pathology and cost benefit analysis of hernia sacs processed over a 19-year period
Arshia Kazerouni1, Klaudia M Nowak1, Stefano Serra1
1Department of Pathology, University Health Network Laboratory Medicine Program, University of Toronto, Toronto, Ontario, Canada.
Insights
Routine pathological examination of hernia sacs is not cost-effective, with 99% showing no abnormalities. Gross examination is sufficient, reserving pathological evaluation for clinically indicated cases to optimize resource use.
Area of Science:
- Pathology
- Surgical Pathology
- Cost-Effectiveness Analysis
Background:
- Hernia sac examination is a common practice in surgical pathology.
- The clinical utility and cost-effectiveness of routine pathological evaluation of hernia sacs remain debated.
- Understanding the diagnostic yield and financial implications is crucial for optimizing healthcare resource allocation.
Purpose of the Study:
- To analyze pathological diagnoses of hernia sacs over a 19-year period.
- To determine the full cost associated with pathological evaluation of hernia sacs.
- To assess the impact of routine pathological examination on patient management and resource utilization.
Main Methods:
- A retrospective analysis of hernia sacs submitted for pathological evaluation from 2001 to 2019.
- Calculation of total costs for complete pathology examination based on average rates and pay.
- Review of pathological diagnoses and correlation with clinical indications.
Main Results:
- 3619 hernia sacs were analyzed, with 3592 undergoing histological evaluation.
- 95.7% of cases showed no pathological abnormality, and 98.9% revealed no significant findings for patient benefit.
- The total cost for pathological examination of 3592 hernia sacs was $95,328.90 over 19 years, averaging $26.90 per specimen.
Conclusions:
- Routine pathological sampling of hernia sacs offers a low return on investment.
- Gross examination is adequate for most cases (99%), minimizing unnecessary costs.
- Selective pathological evaluation should be reserved for cases with specific clinical indications.
Aim:
Hernia sacs with pathological evaluation over a 19-year period were analysed with regards to pathological diagnoses, full costing and the impact on patient management.
Materials And Methods:
The database of the Department of Pathology were searched over the study period (2001 to 2019 inclusive) for hernia sacs. The total cost of complete pathology examination was calculated on average numbers and rates of pay that existed over the study period.
Results:
A total of 3619 hernia sacs from the abdominal, hiatus/diaphragmatic, inguinal and femoral hernias were retrieved. Of these 3592 cases (99.25%) had sections taken for histological evaluation. A total of 3437 cases representing 95.7% of all hernia sacs did not show any pathological abnormality. If non-neoplastic clinically insignificant lesions seen in hernia sacs is included, then 3552 of 3592 (98.9%) hernia sacs underwent full pathological evaluation for no patient benefit.On average two blocks or tissue sections per case were processed incurring a technical cost of $53 175.00. The total pathologist cost in reporting the 3592 cases was approximately $39 870.00 and rose to $40 410.00 when interpretation of ancillary tests was factored in. $95 328.90 (average $26.90 per specimen with a yearly average total cost of $5 017.31) was spent over the 19-year period in full pathological examination of 3592 hernia sacs.
Conclusion:
Given the low return on investment and the difficult to quantify time savings and reallocation, we do not advocate the routine sampling of hernia sacs. Gross examination will suffice in 99% of the cases. Selective cases may be sampled if clinically indicated.
More Related Videos
10:52Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
20:33A Case Series of Successful Abdominal Closure Utilizing a Novel Technique Combining a Mechanical Closure System with a Biologic Xenograft that Accelerates Wound Healing
Published on: July 4, 2019