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Ökonomie der kontralateralen laparoskopischen Leistenexploration

Kostenkalkulation der Herniotomie im Säuglingsalter

The economics of contralateral laparoscopic inguinal hernia exploration

Cost calculation of herniotomy in infants

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Zusammenfassung

Hintergrund

Die diagnostische Laparoskopie (DL) der Gegenseite bei der Leistenherniotomie über den eröffneten Bruchsack erspart dem Patienten eventuell einen Zweiteingriff. Allerdings stellt sich die Frage, ob ein solches Vorgehen unserem Gesundheitssystem Kosten ersparen kann.

Material und Methoden

Die Daten der im Zeitraum März 2006 bis Oktober 2007 in der Klinik und Poliklinik für Kinderchirurgie der Universität Leipzig wegen Leistenhernie (LH) operierten Kinder wurden prospektiv erfasst. Die Kosten wurden für verschiedene Szenarien bestimmt und im Kontext des Risikos einer kontralateralen LH in einem linearen mathematischen Modell hochgerechnet. Daraus ergab sich die Inzidenz, ab der sich DL ökonomisch sinnvoll erscheint.

Ergebnisse

Insgesamt wurden im Beobachtungszeitraum 123 einseitige LH-Operationen (LH-OP) bei Säuglingen operiert. Davon erfolgte bei 31 die DL der Gegenseite. Es fanden sich 13 offene Processi vaginales peritonei, die gleichzeitig versorgt wurden. Folgende Kosten wurden ermittelt: LH-OP ohne DL 286 Euro, LH-OP mit DL der Gegenseite 338 Euro, LH-OP mit DL und synchroner Versorgung der Gegenseite 393 Euro, metachrone Versorgung von bilateralen LH 572 Euro. Die Inzidenz einer kontralateralen LH wird in 20–50% beschrieben. Die lineare Regression der Kosten für die Verfahren zeigt einen ökonomischen Vorteil für die DL oberhalb einer Inzidenz von 23%.

Schlussfolgerung

Die laparoskopische Evaluation der Gegenseite bei der LH-OP ist nicht nur für den Patienten, sondern auch unter Kostenaspekten für das Gesundheitssystem sinnvoll.

Abstract

Background

Diagnostic laparoscopy (DL) of the contralateral side during inguinal herniotomy via the hernia sack may avoid a subsequent second operation. Can this procedure however also reduce costs in the German health care system?

Methods

Prospective analysis was performed of children operated on for inguinal hernia (IH) from March 2006 until October 2007. Using a linear mathematic model, the costs for different scenarios were calculated regarding the risk of contralateral IH. We thereby determined the incidence of contralateral IH at which DL became economically reasonable.

Results

A total of 123 unilateral IH operations (IH-OP) were performed in infants during the study period. Of these, 31 patients underwent DL of the contralateral side. Thirteen open hernia sacks were identified and ligated during the same operation. The following costs were calculated: (1) IH-OP without DL, 286 Euro, (2) IH-OP with contralateral DL, 338 Euro, (3) IH-OP with DL and synchronous ligation of the contralateral side, 393 Euro, and (4) metachronous operations of bilateral IH, 572 Euro. The incidence of contralateral hernia described in the literature ranges from 20% to 50%. Linear regression of the relative costs shows an economic advantage for DL with an incidence above 23%.

Conclusion

Laparoscopic evaluation of the contralateral side in IH-OP is a rational approach for the patient and makes economic sense in the German health care system.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Childern’s Hospital of Alabama, University of Alabama at Birmingham, 1600 7th Avenue South, ACC 300, 35233, Birmingham, Alabama, USA

    O.J. Muensterer & R. Metzger

  2. Klinik und Poliklinik für Kinderchirurgie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland

    T. Woller & H. Till

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  1. O.J. Muensterer
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  2. T. Woller
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  3. R. Metzger
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  4. H. Till
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Correspondence to O.J. Muensterer.

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Muensterer, O., Woller, T., Metzger, R. et al. Ökonomie der kontralateralen laparoskopischen Leistenexploration. Chirurg 79, 1065–1071 (2008). https://doi.org/10.1007/s00104-008-1512-z

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  • DOI: https://doi.org/10.1007/s00104-008-1512-z

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