Time-efficiency and hospital costs of open compared with laparoscopic groin hernia repair in a teaching hospital.

BACKGROUND: Time efficiency and hospital costs may influence the preferred method of groin hernia repair. Despite growing expertise in laparoscopic hernia repair, knowledge on the actual costs and the potential financial advantages over open hernia repair are limited. METHODS: A single-center retrospective cohort study comparing hospital costs and time-efficiency of open-mesh (Lichtenstein) and laparoscopic groin hernia repair between 2010 and 2015, including a comparison of surgeons and residents, was conducted. Secondary outcomes were length of hospital stay, complication and recurrence rates. RESULTS: Nine hundred forty-seven open and 449 laparoscopic groin hernia repairs were included. Unilateral open repair showed a shorter operation theatre occupancy (63.5 min±17.2 vs. 71.9 min±19.9, P<0.001) and lower total costs (€ 974.51±266.67 vs. € 1165.32±285.94, P<0.001) compared with laparoscopic repair. Residents had longer operative times compared with surgeons in the unilateral open procedure (43.8±13.4 min vs. 34.5±16.3 min, P<0.001), in the unilateral laparoscopic procedure (46.9±16.6 min vs. 41.7±18.7 min, P<0.001) and higher total costs in the unilateral open procedure (€ 1007.47±238.58 vs. € 909.35±305.00, P<0.001). There were no significant differences in complication and recurrence rates between residents and surgeons. CONCLUSIONS: Open-mesh hernia repair appears to be superior in costs for both uni- and bilateral groin hernias when performed by surgeons as well as residents. Residents had higher total costs and longer operation times in the unilateral open groin hernia group when compared with surgeons, yet overall complications and recurrence rates were similar in all groups suggesting that residents are sometimes more expensive and slower, but just as safe.

Pregnancy after abdominoplasty with mesh placement: A case report.

A 32-year-old Caucasian female, who had an abdominoplasty with sublay mesh placement for rectus abdominis diastasis becamepregnant one year later. The gestation was uneventful and the baby was born healthy after 40 weeks of pregnancy. During and after the pregnancy the patient's abdomen had been evaluated intensively and there was no recurrence of rectus abdominis diastasis. In this particular case the tissues of the abdominal wall elongated as the foetus grew larger, except for the site where the rectus diastasis has been corrected. The experience with this particular case does not assure that all patients will have the same uneventful outcomes as described. Nonetheless, it shows that pregnancy after abdominoplasty with mesh placing for rectus abdominis diastasis can be safe for both mother and child. However, each patient must be informed about the risks of pregnancy in this particular situation and professional follow-up is mandatory when pregnancy does occur. This is, as far as we know, the first case report of an uneventful pregnancy after rectus abdominis diastasis repair with the placement of a sublay mesh and abdominoplasty.