Cutting the cost: Laparoscopic inguinal hernia repair by totally extraperitoneal approach without disposable instruments

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Background: One of the disadvantages of laparoscopic inguinal hernioplasty by the totally extraperitoneal approach is the cost associated with disposable instrumentation that is used to establish and maintain the preperitoneal space. A prospective audit and cost‐analysis of laparoscopic inguinal hernia repair with and without disposable instruments was conducted at the Royal Hobart Hospital, Australia.Methods: The data from 94 patients undergoing laparoscopic inguinal hernioplasty (47 with and 47 without disposable instruments) were reviewed. In the group without disposable instruments, digital dissection supplemented by movements of a 30° laparoscope, and followed by dissection with laparoscopic forceps, was used instead of disposable balloon expanders to establish and maintain the preperitoneal space during hernioplasty. Detailed pre‐, intra‐, and postoperative findings were audited for each laparoscopic inguinal hernioplasty technique. In‐hospital cost analysis was conducted for theatre time, and costs of laparoscopic and disposable instruments were compared.Result: The overall cost saving of not using disposable instrumentation at the initial stage was almost $A20 000 for 47 patients (approximately $A425 per case). The difference in theatre time used was not statistically significant. In the group of hernioplasty without disposable instruments, disposable balloon expanders were still required in three patients (8.2%) due to gas leakage, and one (2.6%) required conversion to open procedure due to profuse bleeding. There were two patients in this group with postoperative complications: one with seroma and one with urinary retention.Conclusion: The preperitoneal space was established and maintained in most patients without using the specially designed balloon expanders. Therefore, this modification of the totally extraperitoneal approach could be considered safe and effective, and should be attempted initially. However, in difficult cases, the disposable balloon expanders may still be required.