Top

Published in:

01-07-2013

Laparoscopic totally extraperitoneal versus open preperitoneal mesh repair for inguinal hernia recurrence: a decision analysis based on net health benefits

Authors: George Sgourakis, Georgia Dedemadi, Ines Gockel, Irene Schmidtmann, Sophocles Lanitis, Paraskevi Zaphiriadou, Athanasios Papatheodorou, Constantine Karaliotas

Published in: Surgical Endoscopy | Issue 7/2013

Abstract

Background

The aim of this study is to evaluate the most cost-effective treatment strategy using preperitoneal mesh for patients with recurrent inguinal hernia. Currently, the issue of cost-effectiveness is entirely unresolved.

Methods

A decision analysis was carried out based on the results of a systematic literature review of articles concerning recurrent inguinal hernia repair that were published between 1979 and 2011. A virtual cohort was programmed to undergo three different treatment procedures: (1) laparoscopic totally extraperitoneal hernia repair (TEP), (2) open preperitoneal mesh repair according to Stoppa, and (3) open preperitoneal mesh repair according to Nyhus. We carried out a base-case analysis and varied all variables over a broad range of reasonable hypotheses in multiple one-way and two-way sensitivity analyses.

Results

The average cost-effectiveness ratio of Nyhus, Stoppa, and TEP per quality-adjusted life year was US $ ($)1,942, $1,948, and $2,011, respectively. In terms of the incremental cost-effectiveness ratio (ICER), Stoppa was dominated. The choice between TEP or Nyhus procedure depends on the combination of a specific center’s rates of recurrence and morbidity as disclosed by three-way sensitivity analysis.

Conclusions

Nyhus and TEP repairs are possible optimal choices depending primarily on the institution’s rates of recurrence and morbidity. Based on our net benefit-related decision analysis, a hypothetical “fixed budget trade-off” suggests potential annual incremental health system cost savings of $200,000 attained by shifting care for 1,000 patients from TEP to Nyhus repair (depending on clinical end-points, which is a decisive factor).

Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, Reda D, Henderson W (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350(18):1819–1827. doi:10.1056/NEJMoa040093 PubMedCrossRef

Beets GL, van Geldere D, Baeten CG, Go PM (1996) Long-term results of giant prosthetic reinforcement of the visceral sac for complex recurrent inguinal hernia. Br J Surg 83(2):203–206PubMedCrossRef

Memon MA, Feliu X, Sallent EF, Camps J, Fitzgibbons RJ Jr (1999) Laparoscopic repair of recurrent hernias. Surg Endosc 13(8):807–810. doi:SRGNDM98-175 PubMedCrossRef

Nyhus LM, Pollak R, Bombeck CT, Donahue PE (1988) The preperitoneal approach and prosthetic buttress repair for recurrent hernia. The evolution of a technique. Ann Surg 208(6):733–737PubMedCrossRef

Stoppa R, Henry X, Verhaeghe P (1996) Repair of inguinal hernias without tension and without suture using a large dacron mesh prosthesis and by pre-peritoneal approach. A method of reference for selective indication. Ann Chir 50(9):808–813PubMed

Wantz GE (1993) Testicular atrophy and chronic residual neuralgia as risks of inguinal hernioplasty. Surg Clin North Am 73(3):571–581PubMed

Liem MS, van der Graaf Y, van Steensel CJ, Boelhouwer RU, Clevers GJ, Meijer WS, Stassen LP, Vente JP, Weidema WF, Schrijvers AJ, van Vroonhoven TJ (1997) Comparison of conventional anterior surgery and laparoscopic surgery for inguinal-hernia repair. N Engl J Med 336(22):1541–1547. doi:10.1056/NEJM199705293362201 PubMedCrossRef

Dedemadi G, Sgourakis G, Radtke A, Dounavis A, Gockel I, Fouzas I, Karaliotas C, Anagnostou E (2010) Laparoscopic versus open mesh repair for recurrent inguinal hernia: a meta-analysis of outcomes. Am J Surg 200(2):291–297. doi:S0002-9610(10)00114-5 PubMedCrossRef

Karthikesalingam A, Markar SR, Holt PJ, Praseedom RK (2010) Meta-analysis of randomized controlled trials comparing laparoscopic with open mesh repair of recurrent inguinal hernia. Br J Surg 97(1):4–11. doi:10.1002/bjs.6902 PubMedCrossRef

10.

www.euroqol.org/home.html. Last accessed 22 April 2011

11.

Alani A, Duffy F, O’Dwyer PJ (2006) Laparoscopic or open preperitoneal repair in the management of recurrent groin hernias. Hernia 10(2):156–158. doi:10.1007/s10029-005-0052-4 PubMedCrossRef

12.

Baroody M, Bansal V, Maish G (2004) The open preperitoneal approach to recurrent inguinal hernias in high-risk patients. Hernia 8(4):373–375. doi:10.1007/s10029-004-0259-9 PubMedCrossRef

13.

Bay-Nielsen M, Kehlet H, Strand L, Malmstrom J, Andersen FH, Wara P, Juul P, Callesen T (2001) Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet 358(9288):1124–1128. doi:S0140-6736(01)06251-1 PubMedCrossRef

14.

Beets GL, Dirksen CD, Go PM, Geisler FE, Baeten CG, Kootstra G (1999) Open or laparoscopic preperitoneal mesh repair for recurrent inguinal hernia? A randomized controlled trial. Surg Endosc 13(4):323–327PubMedCrossRef

15.

Bingener J, Dorman JP, Valdes G (2003) Recurrence rate after laparoscopic repair of recurrent inguinal hernias: have we improved? Surg Endosc 17(11):1781–1783. doi:10.1007/s00464-002-8556-9 PubMedCrossRef

16.

Chiofalo R, Holzinger F, Klaiber C (2001) Total endoscopic pre-peritoneal mesh implant in primary or recurrent inguinal hernias. Chirurg 72(12):1485–1491PubMedCrossRef

17.

Choi YY, Kim Z, Hur KY (2010) The safety and effectiveness of laparoscopic total extraperitoneal (TEP) repair for recurrent inguinal hernia after open hernioplasty. J Laparoendosc Adv Surg Tech A 20(6):537–539. doi:10.1089/lap.2010.0029 PubMedCrossRef

18.

Dedemadi G, Sgourakis G, Karaliotas C, Christofides T, Kouraklis G (2006) Comparison of laparoscopic and open tension-free repair of recurrent inguinal hernias: a prospective randomized study. Surg Endosc 20(7):1099–1104. doi:10.1007/s00464-005-0621-8 PubMedCrossRef

19.

Deysine M (2008) Recurrent inguinal herniorrhaphy: the centripetal approach utilizing a pre-formed polypropylene plug. Hernia 12(3):271–275. doi:10.1007/s10029-008-0335-7 PubMedCrossRef

20.

Farooq O, Batool Z, Din AU, Ullah AA, Butt Q, Kibryia RI (2007) Anterior tension - free repair versus posterior preperitoneal repair for recurrent hernia. J Coll Physicians Surg Pak 17(8):465–468. doi:040579197 PubMed

21.

Feliu X, Torres G, Vinas X, Martinez-Rodenas F, Fernandez-Sallent E, Pie J (2004) Preperitoneal repair for recurrent inguinal hernia: laparoscopic and open approach. Hernia 8(2):113–116. doi:10.1007/s10029-003-0179-0 PubMedCrossRef

22.

Ferzli GS, Khoury GE (2006) Treating recurrence after a totally extraperitoneal approach. Hernia 10(4):341–346. doi:10.1007/s10029-006-0106-2 PubMedCrossRef

23.

Frankum CE, Ramshaw BJ, White J, Duncan TD, Wilson RA, Mason EM, Lucas G, Promes J (1999) Laparoscopic repair of bilateral and recurrent hernias. Am Surg 65(9):839–842 discussion 842-833PubMed

24.

Garg P, Menon GR, Rajagopal M, Ismail M (2010) Laparoscopic total extraperitoneal repair of recurrent inguinal hernias. Surg Endosc 24(2):450–454. doi:10.1007/s00464-009-0602-4 PubMedCrossRef

25.

Goo TT, Lawenko M, Cheah WK, Tan C, Lomanto D (2010) Endoscopic total extraperitoneal repair of recurrent inguinal hernia: a 5-year review. Hernia 14(5):477–480. doi:10.1007/s10029-010-0675-y PubMedCrossRef

26.

Gorog D, Perner F, Kovacs J, Alfoldy F, Mathe Z, Peter A, Szabo J (1997) Our preliminary results in application of Stoppa technique for recurrent groin hernia. Acta Chir Hung 36(1–4):108–109PubMed

27.

Gross E, Kofuncu O (1994) Preperitoneal implantation of Dacron mesh for treatment of recurrent inguinal hernia and bilateral inguinal hernia. Zentralbl Chir 119(4):207–213 discussion 213PubMed

28.

Huang CS (1999) Surgical treatment of recurrent groin hernia. J Formos Med Assoc 98(2):122–127PubMed

29.

Janu PG, Sellers KD, Mangiante EC (1998) Recurrent inguinal hernia: preferred operative approach. Am Surg 64(6):569–573 discussion 573-564PubMed

30.

Jarhult J, Hakanson C, Akerud L (1999) Laparoscopic treatment of recurrent inguinal hernias: experience from 281 operations. Surg Laparosc Endosc Percutan Tech 9(2):115–118PubMedCrossRef

31.

Karatepe O, Acet E, Altiok M, Adas G, Cak RA, Karahan S (2010) Preperitoneal repair (open posterior approach) for recurrent inguinal hernias previously treated with Lichtenstein tension-free hernioplasty. Hippokratia 14(2):119–121PubMed

32.

Katri KM (2009) Open preperitoneal mesh repair of recurrent inguinal hernia. Hernia. doi:10.1007/s10029-009-0585-z PubMed

33.

Knook MT, Weidema WF, Stassen LP, van Steensel CJ (1999) Laparoscopic repair of recurrent inguinal hernias after endoscopic herniorrhaphy. Surg Endosc 13(11):1145–1147PubMedCrossRef

34.

Kouhia ST, Huttunen R, Silvasti SO, Heiskanen JT, Ahtola H, Uotila-Nieminen M, Kiviniemi VV, Hakala T (2009) Lichtenstein hernioplasty versus totally extraperitoneal laparoscopic hernioplasty in treatment of recurrent inguinal hernia—a prospective randomized trial. Ann Surg 249(3):384–387. doi:10.1097/SLA.0b013e318196d0b0 PubMedCrossRef

35.

Kumar S, Nixon SJ, MacIntyre IM (1999) Laparoscopic or Lichtenstein repair for recurrent inguinal hernia: one unit’s experience. J R Coll Surg Edinb 44(5):301–302PubMed

36.

Kurzer M, Belsham PA, Kark AE (2002) Prospective study of open preperitoneal mesh repair for recurrent inguinal hernia. Br J Surg 89(1):90–93. doi:10.1046/j.0007-1323.2001.01956.x PubMedCrossRef

37.

Langer I, Herzog U, Schuppisser JP, Ackermann C, Tondelli P (1996) Preperitoneal prosthesis implantation in surgical management of recurrent inguinal hernia. Retrospective evaluation of our results 1989–1994. Chirurg 67(4):394–402PubMed

38.

Lau H (2004) Endoscopic totally extraperitoneal inguinal hernioplasty for recurrence after open repair. ANZ J Surg 74(10):877–880. doi:10.1111/j.1445-1433.2004.03193.x PubMedCrossRef

39.

Lo Menzo E, Spector SA, Iglesias A, Martinez JM, Huaco J, DeGennaro V, Madan AK (2009) Management of recurrent inguinal hernias after total extraperitoneal (TEP) herniorrhaphies. J Laparoendosc Adv Surg Tech A 19(4):475–478. doi:10.1089/lap.2008.0408 PubMedCrossRef

40.

Lobo E, Sanjuanbenito A, Fernandez-Merino J, Martinez-Molina E (1999) The preperitoneal (posterior) approach to the repair of recurrent inguinal hernia. Hernia 3(2):65–67CrossRef

41.

Mok KT, Wang BW, Chang HT, Liu SI, Jou NW, Tsai CC, Chen IS (1998) Laparoscopic versus open preperitoneal prosthetic herniorrhaphy for recurrent inguinal hernia. Int Surg 83(2):174–176PubMed

42.

Mozingo DW, Walters MJ, Otchy DP, Rosenthal D (1992) Properitoneal synthetic mesh repair of recurrent inguinal hernias. Surg Gynecol Obstet 174(1):33–35PubMed

43.

Read RC (1979) Bilaterality and the prosthetic repair of large recurrent inguinal hernias. Am J Surg 138(6):788–793PubMedCrossRef

44.

Richards SK, Vipond MN, Earnshaw JJ (2004) Review of the management of recurrent inguinal hernia. Hernia 8(2):144–148. doi:10.1007/s10029-003-0194-1 PubMedCrossRef

45.

Rignault DP (1986) Properitoneal prosthetic inguinal hernioplasty through a Pfannenstiel approach. Surg Gynecol Obstet 163(5):465–468PubMed

46.

Sakorafas GH, Nissiotakis C, Chalikias I, Kotsifopoulos N, Stavrou A, Kassaras GA (2005) Open preperitoneal mesh repair of recurrent inguinal and femoral hernias. Mt Sinai J Med 72(5):342–345PubMed

47.

Scheuerlein H, Schiller A, Schneider C, Scheidbach H, Tamme C, Kockerling F (2003) Totally extraperitoneal repair of recurrent inguinal hernia. Surg Endosc 17(7):1072–1076. doi:10.1007/s00464-002-8957-9 PubMedCrossRef

48.

Sevonius D, Gunnarsson U, Nordin P, Nilsson E, Sandblom G (2009) Repeated groin hernia recurrences. Ann Surg 249(3):516–518. doi:10.1097/SLA.0b013e318199f21c PubMedCrossRef

49.

Shah NR, Mikami DJ, Cook C, Manilchuk A, Hodges C, Memark VR, Volckmann ET, Hall CR, Steinberg S, Needleman B, Hazey JW, Melvin WS, Narula VK (2011) A comparison of outcomes between open and laparoscopic surgical repair of recurrent inguinal hernias. Surg Endosc 25(7):2330–2337. doi:10.1007/s00464-010-1564-2 PubMedCrossRef

50.

Staarink M, van Veen RN, Hop WC, Weidema WF (2008) A 10-year follow-up study on endoscopic total extraperitoneal repair of primary and recurrent inguinal hernia. Surg Endosc 22(8):1803–1806. doi:10.1007/s00464-008-9917-9 PubMedCrossRef

51.

Tamme C, Scheidbach H, Hampe C, Schneider C, Kockerling F (2003) Totally extraperitoneal endoscopic inguinal hernia repair (TEP). Surg Endosc 17(2):190–195. doi:10.1007/s00464-002-8905-8 PubMedCrossRef

52.

Tantia O, Jain M, Khanna S, Sen B (2009) Laparoscopic repair of recurrent groin hernia: results of a prospective study. Surg Endosc 23(4):734–738. doi:10.1007/s00464-008-0048-0 PubMedCrossRef

53.

Topal B, Hourlay P (1997) Totally preperitoneal endoscopic inguinal hernia repair. Br J Surg 84(1):61–63PubMedCrossRef

54.

van der Hem JA, Hamming JF, Meeuwis JD, Oostvogel HJ (2001) Totally extraperitoneal endoscopic repair of recurrent inguinal hernia. Br J Surg 88(6):884–886. doi:10.1046/j.0007-1323.2001.01793.x PubMedCrossRef

55.

Wantz GE (1989) Giant prosthetic reinforcement of the visceral sac. Surg Gynecol Obstet 169(5):408–417PubMed

56.

Neuhauser D (1977) Elective inguinal herniorraphy versus truss in the elderly. In: Bunker JP, Barnes BB, Mosteller F (eds) Costs, risks, benefits of surgery. Oxford University Press, New York, pp 223–239

57.

Gallegos NC, Dawson J, Jarvis M, Hobsley M (1991) Risk of strangulation in groin hernias. Br J Surg 78(10):1171–1173PubMedCrossRef

58.

Haapaniemi S, Gunnarsson U, Nordin P, Nilsson E (2001) Reoperation after recurrent groin hernia repair. Ann Surg 234(1):122–126PubMedCrossRef

59.

Stylopoulos N, Gazelle GS, Rattner DW (2003) A cost—utility analysis of treatment options for inguinal hernia in 1,513,008 adult patients. Surg Endosc 17(2):180–189. doi:10.1007/s00464-002-8849-z PubMedCrossRef

60.

Brasel KJ, Borgstrom DC, Weigelt JA (1997) Cost-utility analysis of contaminated appendectomy wounds. J Am Coll Surg 184(1):23–30PubMed

61.

Fracchia JA, Armenakas NA, Kohan AD (1998) Cost-effective hydrocele ablation. J Urol 159(3):864–867PubMedCrossRef

62.

Bay-Nielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233(1):1–7PubMedCrossRef

63.

Callesen T, Bech K, Kehlet H (1999) Prospective study of chronic pain after groin hernia repair. Br J Surg 86(12):1528–1531. doi:10.1046/j.1365-2168.1999.01320.x PubMedCrossRef

64.

Nyhus ML (2002) A 1-stage surgical treatment for postherniorrhaphy neuropathic pain-invited critique. Arch Surg 137:104CrossRef

65.

Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WC (2001) Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 88(8):1122–1126. doi:10.1046/j.0007-1323.2001.01828.x PubMedCrossRef

66.

http://hcupnet.ahrq.gov/. Last accessed 22 April 2011

67.

https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp?_requestid=25528. Last accessed 22 April 2011

68.

http://www.cms.gov/PhysicianFeeSched/downloads/AnesthesiaSharesCY2011.pdf. Last accessed 22 April 2011

69.

www.icer-review.org/index.php?option=com_content&task=blogsection&id=13&Itemid=42. Institute for Clinical and Economic Review. Methodology: ICER Integrated Evidence Rating^TM. Monograph Accessed 23 Dec 2011

70.

Mauskopf JA, Sullivan SD, Annemans L, Caro J, Mullins CD, Nuijten M, Orlewska E, Watkins J, Trueman P (2007) Principles of good practice for budget impact analysis: report of the ISPOR Task Force on good research practices–budget impact analysis. Value Health 10(5):336–347. doi:10.1111/j.1524-4733.2007.00187.x PubMedCrossRef

71.

Eklund A, Rudberg C, Leijonmarck CE, Rasmussen I, Spangen L, Wickbom G, Wingren U, Montgomery A (2007) Recurrent inguinal hernia: randomized multicenter trial comparing laparoscopic and Lichtenstein repair. Surg Endosc 21(4):634–640. doi:10.1007/s00464-006-9163-y PubMedCrossRef

72.

Glick HA, Briggs AH, Polsky D (2001) Quantifying stochastic uncertainty and presenting results of cost-effectiveness analyses. Expert Rev Pharmacoecon Outcomes Res 1(1):25–36. doi:10.1586/14737167.1.1.25 PubMedCrossRef

73.

http://www.sages.org/publication/id/PI06. Last accessed 19 Dec 2011. Accessed 19 Dec 2011

74.

Nord E (1992) Methods for quality adjustment of life years. Soc Sci Med 34(5):559–569PubMedCrossRef

75.

http://www.humana-military.com/south/provider/tools-resources/handbook/anesthesia.asp. Last accessed 22 April 2011

76.

Knook MT, Weidema WF, Stassen LP, van Steensel CJ (1999) Endoscopic total extraperitoneal repair of primary and recurrent inguinal hernias. Surg Endosc 13(5):507–511PubMedCrossRef

77.

Farooq O, Bashir ur R (2005) Recurrent inguinal hernia repair by open preperitoneal approach. J Coll Physicians Surg Pak 15(5):261–265. doi:040579197 PubMed

Title: Laparoscopic totally extraperitoneal versus open preperitoneal mesh repair for inguinal hernia recurrence: a decision analysis based on net health benefits
Authors: George Sgourakis
Georgia Dedemadi
Ines Gockel
Irene Schmidtmann
Sophocles Lanitis
Paraskevi Zaphiriadou
Athanasios Papatheodorou
Constantine Karaliotas
Publication date: 01-07-2013
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 7/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-012-2776-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Laparoscopic totally extraperitoneal versus open preperitoneal mesh repair for inguinal hernia recurrence: a decision analysis based on net health benefits

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2013

Nutritional risk is still a clinical predictor of postoperative outcomes in laparoscopic abdominal surgery

Responsiveness of quality of life instruments for the comparison of minimally invasive cholecystectomy procedures

A retrospective analysis of early and late outcome of biodegradable stent placement in the management of refractory anastomotic colorectal strictures

Perceiving haptic feedback in virtual reality simulators

The ANUBISCOPE® flexible platform ready for prime time: description of the first clinical case

Long-term comparison of laparoscopy-assisted distal gastrectomy and open distal gastrectomy in advanced gastric cancer