Abstract：
BACKGROUND:Laparoscopic cholecystectomy is first-line treatment for uncomplicated gallstone disease in high-income countries due to benefits such as shorter hospital stays, reduced morbidity, more rapid return to work, and lower mortality as well-being considered cost-effective. However, there persists a lack of uptake in low- and middle-income countries. Thus, there is a need to evaluate laparoscopic cholecystectomy in comparison with an open approach in these settings. METHODS:A cost-effectiveness analysis was performed to evaluate laparoscopic and open cholecystectomies at Rwanda Military Hospital (RMH), a tertiary care referral hospital in Rwanda. Sensitivity and threshold analyses were performed to determine the robustness of the results. RESULTS:The laparoscopic and open cholecystectomy costs and effectiveness values were $2664.47 with 0.87 quality-adjusted life years (QALYs) and $2058.72 with 0.75 QALYs, respectively. The incremental cost-effectiveness ratio for laparoscopic over open cholecystectomy was $4946.18. Results are sensitive to the initial laparoscopic equipment investment and number of cases performed annually but robust to other parameters. The laparoscopic intervention is more cost-effective with investment costs less than $91,979, greater than 65 cases annually, or at willingness-to-pay (WTP) thresholds greater than $3975/QALY. CONCLUSIONS:At RMH, while laparoscopic cholecystectomy may be a more effective approach, it is also more expensive given the low caseload and high investment costs. At commonly accepted WTP thresholds, it is not cost-effective. However, as investment costs decrease and/or case volume increases, the laparoscopic approach may become favorable. Countries and hospitals should aspire to develop innovative, low-cost options in high volume to combat these barriers and provide laparoscopic surgery.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Silverstein A,Costas-Chavarri A,Gakwaya MR,Lule J,Mukhopadhyay S,Meara JG,Shrime MGdoi
10.1007/s00268-016-3851-0subject
Has Abstractpub_date
2017-05-01 00:00:00pages
1225-1233issue
5eissn
0364-2313issn
1432-2323pii
10.1007/s00268-016-3851-0journal_volume
41pub_type
杂志文章abstract：:Trends are changing in the management of infants and children with indirect inguinal hernias. Advances in neonatal intensive care have resulted in the survival of many small premature infants who have a high incidence of inguinal hernia. The rate of incarceration, strangulation, and gonadal infarction in these babies ...
journal_title：World journal of surgery
pub_type： 杂志文章,评审
doi：10.1007/BF01658863
更新日期：1989-09-01 00:00:00
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journal_title：World journal of surgery
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journal_title：World journal of surgery
pub_type： 杂志文章,评审
doi：10.1007/BF00308633
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journal_title：World journal of surgery
pub_type： 传,历史文章,杂志文章
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更新日期：1997-03-01 00:00:00
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pub_type： 杂志文章
doi：10.1007/s00268-018-4610-1
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journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s002689900508
更新日期：1998-09-01 00:00:00
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journal_title：World journal of surgery
pub_type： 杂志文章
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journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s002689900436
更新日期：1998-06-01 00:00:00
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journal_title：World journal of surgery
pub_type： 杂志文章,评审
doi：10.1007/BF02067057
更新日期：1992-11-01 00:00:00
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journal_title：World journal of surgery
pub_type： 杂志文章,评审
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更新日期：2020-11-01 00:00:00
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journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-004-7128-7
更新日期：2004-05-01 00:00:00
abstract：BACKGROUND:Pain syndromes of somatic and neuropathic origin are considered to be the main causes of chronic pain after open inguinal hernia repair. Nerve-identification during open hernia repair is suggested to be associated with less postoperative chronic pain. The aim of this study was to define clinically relevant s...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-006-0376-y
更新日期：2007-02-01 00:00:00
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journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-011-1111-x
更新日期：2011-07-01 00:00:00
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journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-010-0715-x
更新日期：2010-11-01 00:00:00
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journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-020-05760-3
更新日期：2020-11-01 00:00:00
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journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-016-3571-5
更新日期：2016-09-01 00:00:00
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journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-005-7695-2
更新日期：2005-05-01 00:00:00
abstract：BACKGROUND:Primary hyperaldosteronism (PHA) is a cause of secondary arterial hypertension potentially curable by laparoscopic unilateral adrenalectomy. We describe the follow-up of these patients according to their medical or surgical treatment. METHODS:We report a retrospective single-center study of 91 patients with...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-014-2461-y
更新日期：2014-07-01 00:00:00
abstract：BACKGROUND AND AIMS:A variety of minimally invasive techniques have been proposed to replace open surgery for the treatment of infected pancreatic necrosis (IPN). In this study, we evaluate the feasibility and safety of the stent-assisted percutaneous endoscopic necrosectomy (SAPEN) procedure. METHODS:Data were collec...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-018-04878-9
更新日期：2019-04-01 00:00:00
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journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-010-0560-y
更新日期：2010-09-01 00:00:00
abstract：BACKGROUND:The incidence of thyroid cancer is increasing globally. This is mainly due to the increase in the detection of small papillary carcinomas, including papillary microcarcinomas (PMC) 1 cm or smaller. It was suggested recently that PMCs are overdiagnosed and overtreated. METHODS:In 1993, the author proposed a ...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-015-3392-y
更新日期：2016-03-01 00:00:00
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journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s002680020083
更新日期：2001-05-01 00:00:00
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journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-010-0455-y
更新日期：2010-07-01 00:00:00
abstract：BACKGROUND:Measurement of the parathyroid hormone (PTH) level following total thyroidectomy (TTx) may allow prediction of postoperative hypocalcemia. We present an algorithmic method of managing hypocalcemia pre-emptively, based on the PTH level 1 h after operation. MATERIALS AND METHODS:We examined 423 consecutive pa...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-009-0348-0
更新日期：2010-03-01 00:00:00
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journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-007-9118-z
更新日期：2008-01-01 00:00:00
abstract：OBJECTIVES:We set out to clarify the clinicopathologic characteristics of colorectal liver metastases with macroscopic intrabiliary tumor growth and to determine optimal surgical management. METHODS:Over 15 years, 6 of 103 patients undergoing hepatectomy for colorectal liver metastases had macroscopic intrabiliary tum...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-006-0205-3
更新日期：2006-10-01 00:00:00
abstract：BACKGROUND:Ultrasound (US) and sestamibi (MIBI) are traditionally considered positive or negative. The purpose of this study was to define and test a new scoring system for MIBI and US and to determine whether this can improve their accuracy for primary hyperparathyroidism. METHODS:This is a prospective study of 200 c...
journal_title：World journal of surgery
pub_type： 杂志文章
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更新日期：2012-10-01 00:00:00
abstract：BACKGROUND:Although ultrasonographic (US) evaluation is currently recommended for the workup of all palpable thyroid nodules, little guidance exists regarding the manner in which US data are to be used. Herein, we examine the available evidence and recommend how US can be used most effectively to predict malignancy. We...
journal_title：World journal of surgery
pub_type： 杂志文章,评审
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更新日期：2008-07-01 00:00:00
abstract：:Evaluation of prognostic factors of adenocarcinoma of Vater's ampulla is still a matter of debate. The aim of this study was to evaluate retrospectively factors that influence early and long-term outcomes in a 20-year single-institution experience on ampullary carcinoma. A total of 94 consecutive patients with ampulla...
journal_title：World journal of surgery
pub_type： 杂志文章
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更新日期：2005-04-01 00:00:00
abstract：INTRODUCTION TO THE PROBLEM:Though declining in the recent decades, high-energy musculoskeletal trauma remains a major contributor to the burden of disease in high-income countries (HICs). However, due to limitations in the available body of the literature, evaluation of this burden is challenging. The purpose of this ...
journal_title：World journal of surgery
pub_type： 杂志文章,评审
doi：10.1007/s00268-018-4742-3
更新日期：2020-04-01 00:00:00
