K. Haukipuro

Comparison of costs between laparoscopic and open Nissen fundoplication: a prospective randomized study with a 3-month followup

BACKGROUNDnLaparoscopic antireflux surgery has replaced conventional operation despite the fact that currently no randomized trials have been published regarding its cost effectiveness. The objective of the present study was to compare costs and some short-term outcomes of laparoscopic and open Nissen fundoplication.nnnSTUDY DESIGNnForty-two patients with documented gastroesophageal reflux disease were randomized between October 1995 and October 1996 to either laparoscopic (LNF) or open (ONF) Nissen fundoplication. Some short-term outcomes, Gastrointestinal Quality of Life Index (GIQLI) hospital costs, and costs to society were assessed. Followup was 3 months.nnnRESULTSnMedians of operation times in the LNF and ONF groups were 98 min and 74 min, respectively. Hospital stay was 2.5 days shorter after laparoscopic operation (LNF 3 days versus ONF 5.5 days). Both operations were equally safe and effective, but the LNF group experienced significantly less pain and fatigue during the first 3 postoperative weeks. Improvement in the GIQLI and overall patient satisfaction were comparable between the methods. Convalescence was faster in the LNF group: return to normal life being 14 versus 31 days and return to work being 21 versus 44 days in the LNF and ONF groups, respectively. Hospital costs were similar,

Comparison of laparoscopic and open Nissen fundoplication 2 years after operation. A prospective randomized trial.

2,981 and

Cost-effective appendectomy : Open or laparoscopic? a prospective randomized study

3,140 in the LNF and ONF groups, respectively, but total costs were lower (

A cost and outcome comparison between laparoscopic and Lichtenstein hernia operations in a day-case unit : A randomized prospective study

7,506 versus

Five-year outcome of laparoscopic and Lichtenstein hernioplasties

13,118) in the LNF group as a result of an earlier return to work.nnnCONCLUSIONSnLNF is superior in cost effectiveness, assuming that the longterm results between the methods are comparable.

The feasibility of telemedicine for orthopaedic outpatient clinicsa randomized controlled trial

AbstractBackground: Laparoscopic operation has replaced the conventional open procedure in the treatment of gastroesophageal reflux disease (GERD) in spite of the fact that long-term results based on controlled clinical trials have been lacking. The objective of this study was to compare outcome, quality of life, and patient satisfaction after laparoscopic and open Nissen fundoplication in a community hospital setting with a 2-year follow-up.nnMethods: Forty-two patients with GERD were randomized to either laparoscopic (LNF) or open (ONF) Nissen fundoplication. Outcome evaluation included reflux symptoms, gastrointestinal quality of life (GIQLI), and upper GI endoscopy.nnResults: Esophagitis was cured among all patients in the LNF group and in 90% of the ONF group. There were two patients (10%) in both groups who had medicine-dependent recurrent reflux together with significant worsening in the GIQLI scores. One patient in the LNF group has been reoperated due to a suture granuloma in the left epigastric port. Two patients in the LNF group needed esophageal dilatation due to persistent dysphagia. GIQLI scores (scale, 0–144) were equally normalized in both groups. Overall, 90% in the LNF and 100% in the ONF group were either satisfied or very satisfied with the operation. There was only one patient (LNF) who would not choose to have the operation again.nnConclusions: Laparoscopic and open Nissen fundoplication seem to be equally effective methods for improving reflux symptoms and quality of life, resulting in a high rate of satisfaction among patients with an intermediate follow-up period of 2 years.n

Videoconferencing for orthopaedic outpatients: one-year follow-up.

AbstractBackground: The aim of this study was to compare the outcome and cost-effectiveness of laparoscopic (LA) and open appendectomy (OA).n Methods: Forty consecutive patients were randomized to either the LA (n= 19) or OA (n= 21) group.n Results: The medians of operative times in the LA and OA groups were 31.5 and 41 min, respectively. The total operation room times were 91 and 82 min, respectively. There was no significant difference in postoperative pain or fatigue, but return to normal life was faster in the LA group (14 versus 26.5 days). The median hospital costs per patient were 8,538 and 6,788 FIM (

Cosmetic results after wire-guided biopsy of benign breast lesions

1 US = 4.6 FIM) in the LA and OA groups, respectively; but the total costs among working patients were lower in the LA group (20,963 versus 27,778 FIM) due to faster return to work.n Conclusions: Laparoscopic appendectomy is as safe as open appendectomy. The hospital costs are higher, but LA offers significant cost savings to the payer for working patients.

The quality of life of gastroesophageal reflux disease patients waiting for an antireflux operation

AbstractBackground: Laparoscopic hernia repair has often been criticized for its high costs.n Methods: To compare the costs of laparoscopic and open hernia repair, 40 patients were randomized for either transabdominal laparoscopic or Lichtenstein mesh repair (under local anesthesia) in a day-case surgery unit.n Results: Median operative times for the laparoscopic and open groups were 62 and 65 min, respectively. Postoperative pain was comparable for the two groups. The period before return to normal life was 14 days in the laparoscopic group and 21 days in the open group. The hospital costs were 2051 FIM (

Use of recombinant human granulocyte-colony stimulating factor in colorectal surgery

1 US = 4.6 FIM) higher in the laparoscopic group, but the total costs for employed patients (including expenses due to lost work days) were lower.n Conclusion: Although the Lichtenstein operation is cheaper for the hospital, the total costs for working patients are lower with the laparoscopic technique, when the cost of lost work days is factored into overall expense.