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As hérnias inguinais são um tipo de hérnia abdominal e uma das anomalias pediátricas mais comuns. Podem surgir ao nascimento ou posteriormente, em ambos os sexos e podem ser unilaterais ou bilaterais. No entanto, são mais frequentes no sexo masculino e do lado direito. A correção deste tipo de hérnias pode ser realizada pela via tradicional ou pela via laparoscópica, mas definir qual a técnica que se deve utilizar e a melhor para a criança ainda é um assunto bastante controverso. Com este trabalho pretendeu-se verificar se é cost effective optar pela laparoscopia em crianças menores de 6 meses. Neste estudo foram analisados 51 lactentes (39 meninos e 12 meninas) operados no CMIN (Centro Materno Infantil do Norte) entre fevereiro de 2016 e abril de 2017. No total foram realizadas 20 cirurgias pela via clássica e 31 pela via laparoscópica. O diagnóstico intraoperatório de hérnia contralateral só é possível através da técnica laparoscópica e este, por vezes, não coincide com o diagnóstico pré-operatório. Na população operada pela via clássica a taxa de bilateralidade aumentou de 20% para 30% e na população operada pela via laparoscópica aumentou de 13% para 55%. A técnica laparoscópica permitiu evitar 13 segundos tempos cirúrgicos. O material específico necessário para uma cirurgia clássica tem um custo de 25,91€ e para a cirurgia laparoscópica tem um custo de 190,82€. Em 2016, um dia de internamento na pediatria médico cirúrgica do CMIN para correção de hérnia inguinal pela via laparoscópica teve um custo médio de 1115,83€ e pela via clássica de 950,92€, o custo médio de uma ida à urgência foi igual a 357€ e de uma consulta de follow-up foi de 46€. Em 2017, os valores foram diferentes: 1145,66€; 980,75€; 303€ e 42€ respetivamente. O CMIN gastou cerca de 58 311,10€ com as cirurgias dos 51 lactentes analisados, sendo que, cerca de 4028,25€ foram gastos nas segundas cirurgias já realizadas. Através deste estudo concluiu-se que se existir um diagnóstico pré-operatório de hérnia bilateral é mais benéfico realizar a cirurgia pela via laparoscópica e que com o uso rotineiro da técnica laparoscópica o CMIN conseguirá evitar gastos com segundas operações.
Inguinal hernias are a type of abdominal hernia and one of the most common pediatric anomalies. They may occur at birth or later in both sexes and may be unilateral or bilateral. However, they are more common in males and on the right side of the abdomen. The correction of this type of hernia can be done through the traditional or laparoscopic method, however deciding what is the best technique to use in this kind of situation is still a controversial matter. With this work, it was intended to verify if it is cost effective to opt for laparoscopy in children under 6 months. In this study, 51 latent patients (39 boys and 12 girls) operated at CMIN (Centro Materno Infantil do Norte) between February 2016 and April 2017 were the sample of analysis. Overall, 20 surgeries were performed under the classic method and 31 under the laparoscopic one. The intraoperative diagnosis of contralateral hernia is only possible through the laparoscopic technique and this technique sometimes does not coincide with the preoperative diagnosis. In the classically operated population, the bilateral rate increased from 20% to 30% and in the laparoscopic population increased from 13% to 55%. The laparoscopic technique allowed to avoid 13 seconds surgical times. The material needed for classic surgery costs 25,91€ and for the laparoscopic surgery costs 190,82€. In 2016, one day of hospitalization in the medical pediatric surgery of CMIN for correction of this type of hernias under the laparoscopic method had an average cost of 1118,93€ and the classic of 955,01€, the average cost of going to the emergency room was 357€ and a follow-up appointment was 46€. In 2017, the amounts were different: 1148,82€; 989,33€; 303€ and 42€ respectively. CMIN spent about 58 311,10€ with the surgeries of the 51 latent patients analyzed, of which 4028,25€ was spent on the second surgeries that have already been performed. Through this study, we concluded that if there is a preoperative diagnosis of bilateral hernia, it is more beneficial to perform laparoscopic surgery and that with the routine use of the laparoscopic technique CMIN can save the necessary spending of a second operation.
Inguinal hernias are a type of abdominal hernia and one of the most common pediatric anomalies. They may occur at birth or later in both sexes and may be unilateral or bilateral. However, they are more common in males and on the right side of the abdomen. The correction of this type of hernia can be done through the traditional or laparoscopic method, however deciding what is the best technique to use in this kind of situation is still a controversial matter. With this work, it was intended to verify if it is cost effective to opt for laparoscopy in children under 6 months. In this study, 51 latent patients (39 boys and 12 girls) operated at CMIN (Centro Materno Infantil do Norte) between February 2016 and April 2017 were the sample of analysis. Overall, 20 surgeries were performed under the classic method and 31 under the laparoscopic one. The intraoperative diagnosis of contralateral hernia is only possible through the laparoscopic technique and this technique sometimes does not coincide with the preoperative diagnosis. In the classically operated population, the bilateral rate increased from 20% to 30% and in the laparoscopic population increased from 13% to 55%. The laparoscopic technique allowed to avoid 13 seconds surgical times. The material needed for classic surgery costs 25,91€ and for the laparoscopic surgery costs 190,82€. In 2016, one day of hospitalization in the medical pediatric surgery of CMIN for correction of this type of hernias under the laparoscopic method had an average cost of 1118,93€ and the classic of 955,01€, the average cost of going to the emergency room was 357€ and a follow-up appointment was 46€. In 2017, the amounts were different: 1148,82€; 989,33€; 303€ and 42€ respectively. CMIN spent about 58 311,10€ with the surgeries of the 51 latent patients analyzed, of which 4028,25€ was spent on the second surgeries that have already been performed. Through this study, we concluded that if there is a preoperative diagnosis of bilateral hernia, it is more beneficial to perform laparoscopic surgery and that with the routine use of the laparoscopic technique CMIN can save the necessary spending of a second operation.
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Keywords
Hérnia inguinal Cirurgia tradicional Cirurgia laparoscópica Custos associados Benefícios Inguinal hernia Traditional surgery Laparoscopic surgery Associated costs Benefits