Impact of endovascular-assisted in situ saphenous vein bypass technique on hospital costs.

Our initial experience with endovascular-assisted in situ saphenous vein bypass (EISVB) showed patency rates to be comparable to those with conventional in situ bypass, and resulted in a significant reduction in wound-related complications and hospital length of stay (LOS). Here we evaluate the relative costs of these two approaches. Forty-four patients underwent 46 EISVB procedures using endovascular cannulation and coil occlusion of the saphenous vein side branches. Costs for each patient for the operation, the associated hospital stay, and any postoperative care were assessed. These costs were compared to those of the last 46 conventional open in situ bypass procedures as an historical comparison group. The two groups were statistically similar for all parameters except distal outflow target, with the comparison group having statistically more pedal bypasses (p = 0.004). Subset analysis was performed by subdividing each operative group, into those with popliteal and those with distal bypasses. The results of our analysis led us to conclude that the shorter LOS following EISVB more than compensates for the initial cost incurred by the side branch occlusion system. This shorter stay translates into an overall cost savings for EISVB compared to the cost of conventional in situ bypass. The reductions in wound-related morbidity and recovery time postoperatively with EISVB add an additional long-term cost benefit.

A critical appraisal of laparoscopic staging in hepatobiliary and pancreatic malignancy.

Prognosis for patients with hepatobiliary and pancreatic cancers is dismal. Surgery is the best therapeutic option for those with tumors which have not yet metastasized. Standard radiologic tests such as computed tomography (CT) scan and trans-abdominal ultrasound are useful in identifying patients for whom an attempt at resection would be futile. Staging laparoscopy with laparoscopic ultrasound allows greater precision in identifying those for whom resection would be helpful with less morbidity than an open exploration. Metastatic disease can be identified more precisely than with radiologic tests and can be characterized by biopsy techniques. Palliative procedures are now being performed laparoscopically with low morbidity and short hospital stays. The use of laparoscopy prior to open exploration for patients with hepatobiliary and pancreatic tumors is advantageous.