• Benedetto Ielpo, Javier Nuñez-Alfonsel, Hipolito Duran, Eduardo Diaz, Isabel Fabra, Riccardo Caruso, Luis Malavé, Valentina Ferri, Ernesto Barzola, Yolanda Quijano, and Emilio Vicente.
• General Surgery Department, HM Sanchinarro Hospital, San Pablo University of Madrid, Sanchinarro University Hospital, Madrid, Spain.
• Ann. Surg. 2018 Nov 1; 268 (5): 725-730.

ObjectiveThe aim of this study is to compare the clinical and cost-effective outcomes of the open Lichtenstein repair (OL) and laparoscopic trans-abdominal preperitoneal (TAPP) repair for bilateral inguinal hernias.Summary Background DataA cost-effective analysis of laparoscopic versus open inguinal hernia repair is still not well addressed, especially regarding bilateral hernia.MethodsThis is a clinical and cost-effectiveness analysis within a randomized prospective study conducted at Sanchinarro University Hospital.Cases of primary, reducible bilateral inguinal hernia were included and randomized using a simple randomization program.The outcome parameters included surgical and postoperative costs, quality adjusted life years (QALY), and incremental cost per QALY gained or the incremental cost effectiveness ratio.ResultsBetween March 2013 and January 2017, 165 patients were enrolled in this study (81 of them underwent TAPP and 84 OL).The TAPP procedure had less early postoperative pain (P = 0.037), a shorter length of stay (P = 0.001), and fewer postoperative complications (P = 0.002) when compared with the OL approach. The overall cost of TAPP procedure was higher compared with the OL cost (1,683.93&OV0556; vs 1192.83&OV0556;, P = 0.027). The mean QALYs at 1 year for TAPP (0.8094) was higher than that associated with OL (0.6765) (P = 0.018). At a willingness-to-pay threshold of 20,000 &OV0556; and 30,000 &OV0556;, there was a 95.38% and 97.96% probability that TAPP was more cost-effective relative to OL.ConclusionsThe TAPP procedure for bilateral inguinal hernia appears to be more cost-effective compared with OL.

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