Cost-effective Hernia Repair

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To the Editor.—I wholeheartedly agree with Rutkow1 when he questions the universal use of laparoscopic hernia repair. In contrast to the argument that laparoscopic hernia repair saves money, in our geographic area all hernia repairs are done on an outpatient basis. There is no hospital stay required. More disturbing, however, is that the mean charge for a laparoscopic hernia repair at my main hospital is $5000, but $1800 for a conventional repair. My main type of nonlaparoscopic hernia repair uses polypropylene mesh. The length of disability is rarely more than 5 to 6 days. The real question then arises: are the 1 or 2 days of shortened disability really that cost-effective? I do not think so. A sensible approach would be to do primary hernia repairs using conventional methods, preferably with a tension-free repair. I think a good case could be made to repair recurrent hernias, particularly multiple

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