[Cost-effectiveness of hernia repair : IPOM versus open sublay mesh technique]

Analysis of Factors Relevant to Revenue Improvement in Ventral Hernia Repair, Their Influence on Surgical Training, and Development of Predictive Models: An Economic Evaluation

Background: Ventral hernia repairs (VHR) are frequent but loss- making. This study aims to identify epidemiological and procedure related factors in VHR and their influence on surgical training. Methods: Data from 86 consecutive patients who underwent VHR in 2019 was collected. Moreover, 66 primary ventral hernias and 20 incisional hernias were repaired in open procedures. Linear regression models were made. Results: Primary VHR procedures showed a mean deficit of −378.17 CHF per case. Incisional hernia repair procedures resulted in a deficit of −1442.50 CHF per case. The two hernia groups were heterogeneous. For the primary VHR procedures, the surgery time (β = 0.564, p < 0.001) had the greatest influence, followed by the costs of the mesh (β = −0.215, p < 0.001). The epidemiological factors gender (β = 0.143, p < 0.01) and body mass index (BMI) (β = −0.087, p = 0.074) were also influential. For incisional hernia procedures a surgeon’s experience had the most significant influence (β = 0.942, p < 0.001), and the second largest influence was the price of the mesh (β = −0.500, p < 0.001). The epidemiological factor BMI (β = −0.590, p < 0.001), gender (β = −0.113, p = 0.055) and age (β = −0.026, p < 0.050) also had a significant influence. Conclusion: Our analysis shows a way of improving financial results in the field of ventral hernia repair. Costs can be visualized and reduced to optimize revenue enhancement in surgical departments. In our analysis primary ventral hernias are an appropriate training operation, in which the experience of the surgeon has no significant impact on costs. In primary VHR procedures, revenue enhancement is limited when using an expensive mesh. However, the treatment of incisional hernias is recommended by specialists. The financial burden is significantly higher with less experience. Therefore, these operations are not suitable for surgical training. The re-operation rate decreases with increasing experience of the surgeon. This directly affects the Patient Related Outcome (PROM) and quality of treatment. Therefore, high-quality training must be enforced. Since financial pressure on hospitals is increasing further, it is crucial to investigate cost influencing factors. The majority of Swiss public hospitals will no longer be able to operate ventral hernias profitably without new concepts. In addition to purchasing management, new construction projects, and mergers, improving the results of individual departments is a key factor in maintaining the profitability of hospitals in the future regarding hernia repair without losing the scope of teaching procedures.

Parastomal Hernia Repair With 3-D Mesh Implants After Radical Cystectomy and Ileal Conduit Urinary Diversion - A Single-center Experience Using a Purpose Made Alloplastic Mesh Implant

OBJECTIVE

To report and evaluate our open surgical technique for the treatment of parastomal hernias (PSH) after ileal conduit urinary diversion and results using a specifically designed, three-dimensional intraperitoneal onlay mesh aiming to minimize PSH recurrence and perioperative complications.

METHODS

We retrospectively evaluated all patients who developed a PSH after ileal conduit urinary diversion and were treated with the 3-dimensional alloplastic IPST mesh at the Marien Hospital Herne, Ruhr-University Bochum, Germany between 01/2009 and 12/2015. As a surgical approach, we used a small, open incision in order to reduce the hernia sac and place the mesh. Subsequently, we performed a voluntary follow-up of the surviving patients to evaluate long-term recurrence and complication rates. In addition, we conducted a reassessment of the cross-sectional imaging available.

RESULTS

Between January 2009 and December 2015, 40 patients underwent hernia repair due to a clinically significant hernia. Out of those patients, 1 suffered from a postoperative wound infection. In total 27 patients participated in a voluntary follow-up with a median follow-up period of 29 months (IQR 16, 63 months). Follow-up examination revealed 2 cases of recurrent PSH (7, .4%), 2 patients who developed stoma stenosis (7.4%) and 5 patients who suffered from minor complications (18.5%).

CONCLUSION

Our localized open surgical approach using a 3-dimensional mesh implant presents an effective method of treating a PSH with a low complication and recurrence rate.