Cost-effectiveness of alternative methods of surgical repair of inguinal hernia

Objectives: To assess the relative cost-effectiveness of laparoscopic methods of inguinal hernia repair compared with open flat mesh and open non-mesh repair. Methods: Data on the effectiveness of these alternatives came from three systematic reviews comparing: (i) laparoscopic methods with open flat mesh or non-mesh methods; (ii) open flat mesh with open non-mesh repair; and (iii) methods that used synthetic mesh to repair the hernia defect with those that did not. Data on costs were obtained from the authors of economic evaluations previously conducted alongside trials included in the reviews. A Markov model was used to model cost-effectiveness for a five-year period after the initial operation. The outcomes of the model were presented using a balance sheet approach and as cost per hernia recurrence avoided and cost per extra day at usual activities. Results: Open flat mesh was the most cost-effective method of preventing recurrences. Laparoscopic repair provided a shorter period of convalescence and less long-term pain compared with open flat mesh but was more costly. The mean incremental cost per additional day back at usual activities compared with open flat mesh was €38 and €80 for totally extraperitoneal and transabdominal preperitoneal repair, respectively. Conclusions: Laparoscopic repair is not cost-effective compared with open flat mesh repair in terms of cost per recurrence avoided. Decisions about the use of laparoscopic repair depend on whether the benefits (reduced pain and earlier return to usual activities) outweigh the extra costs and intraoperative risks. On the evidence presented here, these extra costs are unlikely to be offset by the short-term benefits of laparoscopic repair.Luke Vale, Adrian Grant, Kirsty McCormack, Neil W. Scott and the EU Hernia Trialists Collaboratio

Open surgery simulation of inguinal hernia repair.

International audienceInguinal hernia repair procedures are often one of the first surgical procedures faced by junior surgeons. The biggest challenge in this procedure for novice trainees is understanding the 3D spatial relations of the complex anatomy of the inguinal region, which is crucial for the effective and careful handling of the present anatomical structures in order to perform a successful and lasting repair. Such relationships are difficult to illustrate and comprehend through standard learning material. This paper presents our work in progress to develop a simulation-based teaching tool allowing junior surgeons to train the Lichtenstein tension-free open inguinal hernia repair technique for direct and indirect hernias, as well as to enforce their understanding of the spatial relations of the involved anatomy

Economic Analysis of Children's Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis.

BackgroundUnderstanding the economic value of health interventions is essential for policy makers to make informed resource allocation decisions. The objective of this systematic review was to summarize available information on the economic impact of children's surgical care in low- and middle-income countries (LMICs).MethodsWe searched MEDLINE (Pubmed), Embase, and Web of Science for relevant articles published between Jan. 1996 and Jan. 2015. We summarized reported cost information for individual interventions by country, including all costs, disability weights, health outcome measurements (most commonly disability-adjusted life years [DALYs] averted) and cost-effectiveness ratios (CERs). We calculated median CER as well as societal economic benefits (using a human capital approach) by procedure group across all studies. The methodological quality of each article was assessed using the Drummond checklist and the overall quality of evidence was summarized using a scale adapted from the Agency for Healthcare Research and Quality.FindingsWe identified 86 articles that met inclusion criteria, spanning 36 groups of surgical interventions. The procedure group with the lowest median CER was inguinal hernia repair ($15/DALY). The procedure group with the highest median societal economic benefit was neurosurgical procedures ($58,977). We found a wide range of study quality, with only 35% of studies having a Drummond score ≥ 7.InterpretationOur findings show that many areas of children's surgical care are extremely cost-effective in LMICs, provide substantial societal benefits, and are an appropriate target for enhanced investment. Several areas, including inguinal hernia repair, trichiasis surgery, cleft lip and palate repair, circumcision, congenital heart surgery and orthopedic procedures, should be considered "Essential Pediatric Surgical Procedures" as they offer considerable economic value. However, there are major gaps in existing research quality and methodology which limit our current understanding of the economic value of surgical care

Learning inguinal hernia repair? A survey of current practice and of preferred methods of surgical residents

Purpose: During surgical residency, many learning methods are available to learn an inguinal hernia repair (IHR). This study aimed to investigate which learning methods are most commonly used and which are perceived as most important by surgical residents for open and endoscopic IHR. Methods: European general surgery residents were invited to participate in a 9-item web-based survey that inquired which of the learning methods were used (checking one or more of 13 options) and what their perceived importance was on a 5-point Likert scale (1 = completely not important to 5 = very important). Results: In total, 323 residents participated. The five most commonly used learning methods for open and endoscopic IHR were apprenticeship style learning in the operation room (OR) (98% and 96%, respectively), textbooks (67% and 49%, respectively), lectures (50% and 44%, respectively), video-demonstrations (53% and 66%, respectively) and journal articles (54% and 54%, respectively). The three most important learning methods for the open and endoscopic IHR were participation in the OR [5.00 (5.00–5.00) and 5.00 (5.00–5.00), respectively], video-demonstrations [4.00 (4.00–5.00) and 4.00 (4.00–5.00), respectively], and hands-on hernia courses [4.00 (4.00–5.00) and 4.00 (4.00–5.00), respectively]. Conclusion: This study demonstrated a discrepancy between learning methods that are currently used by surgical residents to learn the open and endoscopic IHR and preferred learning methods. There is a need for more emphasis on practising before entering the OR. This would support surgical residents’ training by first observing, then practising and finally performing the surgery in the OR

Ultrasound-guided dissection and ligation of the internal inguinal ring for hernia repair in pediatrics: an experimental animal study

Purpose: We aimed to test the feasibility and reliability of ultrasound-guided percutaneous internal inguinal ring suture in rabbits, as a model for inguinal hernia repair in pediatric population. Methods: Twenty-eight rabbits were divided in 2 groups: group I (female morphology) - persistence of the peritoneal-vaginal duct with gonads placed in intraperitoneal position; group II (male morphology) - persistence of the peritoneal-vaginal duct with gonads kept intact inside the duct. Under exclusive ultrasound-guided image we tried to perform a complete pre-peritoneal ligation of the peritoneal-vaginal duct at the level of the internal inguinal ring using a 20G peripheral IV catheter and 2-0 non-absorbable suture. Afterwards, an exploratory laparoscopy was performed to evaluate the ligation. Results: Ultrasound allowed characterization of inguinal-crural structures. Group I - complete and reliable suture 66.7%, incomplete but reliable suture 16.7%, inappropriate ligation 16.7%; group II - complete but unreliable suture 76.9%, incomplete and unreliable suture 11.5%, inappropriate suture 11.5%. No acute complications were logged. Conclusions: Percutaneous dissection and ligation of internal inguinal ring through exclusive ultrasound guidance was feasible and likely reliable, namely for female inguinal hernia repair.Fundação para a Ciência e Tecnologia (FCT), co-funded by Programa Operacional Regional do Norte (ON.2—O Novo 267 Norte); from the Quadro de Referência Estratégico Nacional (QREN) through the Fundo Europeu de Desenvolvimento Regional (FEDER) and from the Projeto Estratégico – LA 26 – 2013–2014 (PEst-C/SAU/LA0026/2013)info:eu-repo/semantics/publishedVersio

Factors Influencing Choice of Inguinal Hernia Repair Technique

Background: Inguinal hernia repair surgery is one of the most frequently performed surgical procedures worldwide. This study sought to highlight factors that may influence decisions concerning inguinal hernia repair techniques.Methods: This descriptive crosssectional study was carried out in September 2014 among surgical trainees and surgeons.Data collected included: qualification of the operating doctor, level at which practical training on inguinal hernia repair occurred, awareness of the various inguinal hernia repair methods, inguinal hernia repair method(s) used for the past three (most recent) inguinal hernia operations and reasons for using that /those repair method(s).Results: Fifteen surgeons and sixty surgical trainees were recruited. Awareness levels and practical training were highest in the modified Bassini and Lichtenstein repair techniques. Experienced peers play a major role in training on the various repair techniques. The modified Bassini technique is preferred in emergency inguinal hernia repair; conversely, open mesh repair (Lichtenstein and PHS/plug) is preferred in elective cases. Reasons influencing choice of repair technique include training on the technique among others.Conclusion: Multiple factors affect the choice of inguinal hernia repair technique some of which are based on evidence while others are attributed to availability of resources and training (or lack thereof).Key words: Inguinal Hernia, Surgical Technique, Choice of Techniqu

Surgical treatment of inguinal hernia: Our experience

Aim: In present retrospective analysis, we aimed to evaluate the treatment results of subjects with inguinal hernia whom underwent surgical repair. Methods: Surgical treatment of inguinal hernia for last 7 years have been retrospectively analyzed. Surgical procedures include anterior mesh, posterior mesh, Mc Vay, non-mesh repair, plug mesh. Results: A total of 2320 patients underwent hernia surgery were included to the study. While, 2224 of the cases were elective procedures while 96 were operated in emergency conditions. Incarceration 78 of emergent cases were incarcerated and 18 were strangulated. Patients requiring emergency surgery were significantly older than the patients underwent elective hernia repair. Duration of hospital stay was significantly longer in emergent cases compared to elective cases. Need for intestinal resection was more common in emergent cases compared to elective surgery cases. Mc Vay and plug mesh procedures were more commonly used in emergent cases compared to elective surgery cases. Intestinal laceration and development of recurrences were more common in emergent surgery cases compared to elective surgery. Conclusion: Inguinal hernia patients should be scheduled for elective surgery without delay since need for emergent surgery may increase by time and emergent cases are associated with more complications and surgical morbidity