Three port laparoscopic appendectomy technique with low cost and aesthetic advantage / Técnica de apendicectomia laparoscópica com três portais de baixo custo e benefício estético

INTRODUCTION: Despite dating more than 30 years after the first laparoscopic appendectomy, ileocecal appendix resection is still performed by laparotomy in more than 90% of cases, in our country. AIM: To describe a technique for laparoscopic removal of the ileocecal appendix with three portals, at low cost and very good aesthetic appearance. TECHNIQUE: Three incisions, one umbilical and two suprapubic are made; permanent material used comprises: grasping forceps, hook, scissors, needle holders, three metal trocars and four other usual instruments, and a single strand of cotton. There is no need to use of operative extractors bags, clips, endoloops, staples or bipolar or harmonic energy instruments. Allows triangulation and instrumentation in the conventional manner. CONCLUSION: The proposed technique is safe and reproducible, easily teachable, at very low cost and can be applied in general hospitals with conventional laparoscopic equipment. .

INTRODUÇÃO: Apesar de datar mais de 30 anos da primeira apendicectomia videolaparoscópica, a apendicectomia ainda é realizada por laparotomia em mais de 90% dos casos em nosso país. OBJETIVO: Descrever uma técnica para retirada laparoscópica do apêndice ileocecal com três portais, com muito baixo custo em insumos e de muito bom aspecto estético. TÉCNICA: São feitas três punções, uma umbilical e duas suprapúbicas; o material permanente utilizado compreende: pinça de apreensão, gancho, tesoura, porta-agulhas, três trocárteres metálicos e outros quatro instrumentos usuais, além de um único fio de algodão. Não há necessidade do uso de bolsas extratoras da peça operatória, clipes, alças, grampeadores ou instrumentos de energia especial, bipolar ou harmônica. Permite triangulação e instrumentação da forma convencional. CONCLUSÃO: A técnica proposta é segura e reprodutível, facilmente ensinada, de muito baixo custo podendo ser aplicada em hospitais gerais com equipamento laparoscópico convencional. .

Clip-closure of appendix stump

An inadequate closure of the appendix stump leads to intra-abdominal surgical site infection. Many studies show that the use of costly high tech instruments such as Endo-loops, Endo-GIA for transaction and closure of the appendiceal stump lowers the risk of infection. The Aim of this study was to evaluate the use of clips for closure of appendix stump as a safe and cost-effective method. Descriptive Study. Oct 2009 to Jun 2010. Shalamar Hospital, Lahore. Over a period of 9 months 36 patients were selected to have laparoscopic appendicectomy. All patients had stump closure by clips as used for cystic duct and cystic artery in laparoscopic cholecystectomy. No patient had Endo-loop or Endo-GIA for closure of stump. All patients had follow-up at one week and six weeks after discharge from hospital. There was no clinical evidence of surgical site infection or leak from appendicular stump by this method. There was no discomfort in handling this instrument both for surgeon and scrub nurse. The price of the clips used was 4.30 Euros as compared to 112.00 and 232.77 Euros for the Endo-loops and Endo-GIA respectively. This study shows that clips can be used for stump closure without any additional risk to patient. It is also cost- effective. So appendiceal stump closure using clips is very convenient, an easy, safe, and cost-effective procedure

Una aproximación al estudio de costos de servicios de salud en México / An approach to the study of helth services costs in Mexico

Objetivo. Abordar el análisis de costos de servicios de salud en eventos trazadores para instituciones de los sectores público y privado en México. Material y métodos. A partir de las funciones de producción y los insumos requeridos para el manejo de casos estándar de cada enfermedad o evento, se procedió a hacer el ajuste en el manejo de los trazadores para cada institución, mediante la técnica de consenso y con la participación de expertos por institución. Identificados los insumos y cantidades para la producción de servicios especificos de salud, se determinaron los costos de manejo de caso. Como trazadores se seleccionaron: hipertensión, diabetes, diarreas, neumonías, apendicectomía, atención del parto, consulta típica y vacunas. Se incluyeron tres instituciones del sector público y cinco del sector privado. Resultados. Los resultados indican que al determinar y comparar el costo de manejo de caso para cada trazador existen diferencias significativas para fines de producción de servicios médicos entre ambos sectores y al interior de cada uno. Conclusiones. El análisis comparativo en el costo de manejo de caso para cada trazador, presenta diferencias que se explican por procesos cualitativos y cuantitativos que caracterizan a cada institución en la combinación de insumos para producir servicios y por los distintos costos de insumos para cada uno de los sectores analizados, resultando los costos más bajos en instituciones del sector público, particularmente en la Secretaría de Salud, y los costos más altos en el sector privado, particularmente en seguros médicos privados

Objective. To approach the cost analysis of the health services for eight tracer conditions, in three institutions of the public sector and in five of the private sector. Material and Methods. First, production functions and inputs required for standard case-management of each tracer condition were identified. Subsequently, tracer case-management was adjusted for each institution through expert consensus techniques. Once the type and amount of inputs necessary to produce tracer-specific health care services were identified, case-management costs were estimated. Tracer conditions were: hypertension, diabetes, diarrheas, pneumonia, appendicectomy, labor and delivery care, routine ambulatory medical care and vaccines. Results. Results indicate significant differences with regards to the production of medical services between both sectors and within each one. Conclusions. The comparative analysis in the cost per case-management for each tracer presents differences that could be explained due to the quantitative and qualitative processes that characterized each institution in the combination of inputs to produce services and for the different costs of the inputs for each of the sectors analyzed, resulting in lower costs in the public sector and higher costs in the private sector, particularly for private health insurance.