Laparoscopy versus Shouldice procedure for treatment of unilateral inguinal hernia: is it possible to reduce the operative overcost?

Aims. - Laparoscopy is more expensive than Shouldice procedure for inguinal hernia repair. The aims of this study were to evaluate the overcost, to lo ok for its causes and to propose a strategy of cost reduction. Methods. - One hundred and sixty three unilateral inguinal hernia repairs w ere performed from January 1995 to June 1996 in our institution, functionin g under financial rule of total endowment. Forty five of the 163 procedures were laparoscopic procedures. The mean operative cost of each procedure wa s calculated from physician, personnel and equipment costs (amortization, c onsumable products and maintenance). Results. - The mean costs were 2 210 FF and 6 779 FF for Shouldice and lapa roscopic procedures, respectively. This overcost of 4 569 FF was seduced to 893 FF by increasing surgeon's experience, which shortened operative durat ion and ward cost, and by the use of a non specific mesh fastened in place with threads. The mean operative cost of laparoscopy was then 3 103 FF. Conclusion. - A change in surgical practice allows a reduction in the opera tive overcost of laparoscopic unilateral inguinal hernia repair by 80.4 %.