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Free-flap breast reconstruction: cost analysis in the Swiss healthcare system

Original article
Scampa M, Petrou I, Modarressi A
Swiss Med Wkly. 2021;151:w20530

Breast cancer is the most common type of malignancy among women. Mastectomy maintains an essential role in oncological therapy and led to the development of breast reconstruction procedures. The deep inferior epigastric perforator (DIEP) free flap became in the last decade a popular approach for breast reconstruction. Although this procedure is known to be more complex than other techniques, it offers one of the highest patient satisfaction rates. However, the cost-effectiveness of this technique has rarely been assessed; and the real cost coverage by health insurance has never been studied. 

Surgical therapy of lymphoedema in Switzerland: challenge for the surgeon with benefit for the patient?

Viewpoint
Harder Y, Wagner S
Swiss Med Wkly. 2021;151:w20504

Since evidence emphasises more and more the effectiveness, appropriateness and cost-efficiency of physiological lympho-reconstructive procedures, the authors are of the opinion that, in the future, insurance companies will need to reimburse costs of microsurgical surgical treatment for lymphoedema.

Insurance coverage policies for reconstructive lymphatic microsurgery procedures in Switzerland

Original article
Uyulmaz S, Fejes A, Grünherz L, Giovanoli P, Lindenblatt N
Swiss Med Wkly. 2021;151:w20456

Insurance companies in Switzerland do not have a uniform policy regarding cost coverage for lymphatic surgery procedures. Moreover, the decision process appeared to be rather uniform within the respective insurance company and independent of the individual case. Standardised evaluation criteria including patient reported outcome measures should be developed to underscore the beneficial effects of lymphatic surgery and facilitate insurance coverage.

ASA score and procedure type predict complications and costs in maxillofacial reconstructive surgery: a retrospective study using a hospital administrative database

Original article
Mehra T, Schönegg D, Ebner J, Moos RM, Schumann P, Gander T, Essig H, Lanzer M
Swiss Med Wkly. 2021;151:w20497

The ASA score allows a reliable preoperative assessment of patient outcomes and financial burden in maxillofacial reconstructive flap surgery. The type of flap reconstruction significantly influences complications and ultimately total costs. The current reimbursement system via diagnosis-related groups (DRGs) does not take sufficient account of this fact. Adaptations are therefore needed to prevent misplaced incentives to the detriment of patients.

Contemporary early results of late repair of tetralogy of Fallot in children: a single-centre case series

Original article
Mottier V, Prsa M
Swiss Med Wkly. 2021;151:w20491

Compared with the existing literature on complete late repair of tetralogy of Fallot in children, this study showed good early results with no mortality, similar rates of reintervention and valve-preserving surgery, higher ICU and hospital length of stay, higher incidence of significant residual right ventricular outflow tract stenosis, and lower incidence of significant pulmonary insufficiency. Repair with a transannular patch was a risk factor for significant residual right ventricular outflow tract stenosis and significant pulmonary insufficiency.

Trapeziometacarpal osteoarthritis – a stepwise therapeutic approach

Review article: Biomedical intelligence
Nuessle NC, Vögelin E, Hirsiger S
Swiss Med Wkly. 2021;151:w20465

Osteoarthritis of the trapeziometarcarpal joint, also called rhizarthrosis, is a common finding in the second half of life. It has a higher prevalence in females and is of growing importance in ageing societies. A variety of conservative and surgical treatment options are known, including conservative treatment up to joint replacement. Without treatment, rhizarthrosis can lead to disabling pain and loss of hand function. The goal of this overview of treatment options is to present a stepwise approach that can be initiated by any physician.

Abdominal wall reconstruction using biosynthetic absorbable mesh in high-risk complex ventral hernia

Original article
Finch D, Mehmood S, Varghese J
Swiss Med Wkly. 2021;151:w20449

Biosynthetic mesh may represent an improvement on biological and large pore synthetic meshes for high-risk complex ventral hernia repair.  This study reports a large series of abdominal wall reconstructions using biosynthetic mesh in complex ventral hernia. The findings indicate promising early outcome data associated with use of biosynthetic mesh. 

Outcome of open inguinal hernia repair using sutureless self-gripping mesh – a retrospective single cohort study

Original article
Schnyder F, Cabalzar-Wondberg D, Raptis DA, Eisner L, Zuber M, Weixler B
Swiss Med Wkly. 2021;151:w20455

This study shows that open inguinal hernia repair using a self-gripping mesh is feasible, with a short operation time and low hernia recurrence rates in a peripheral teaching hospital. However, significant differences in neurological disturbances dependent on the surgeons experience were identified. Especially younger patients should be operated on by an experienced surgeon to reduce neurological disturbances and neuralgia.

Enhanced-view totally extraperitoneal approach in emergency ventral incision hernia repair: a case report

Original article
Nazeeruddin S, Butti F, Herren G
Swiss Med Wkly. 2021;151:w20423

The rate of emergency operations for incarcerated and strangulated ventral hernias is about 10–15%, with worse outcomes than elective surgery. A recent laparoscopic technique called the enhanced-view totally extraperitoneal approach (eTEP) was shown to be indicated in elective repair of ventral and incisional hernias, and has a lower rate of postoperative morbidity than the Rives-Stoppa technique, while having the same indications. However, use of the eTEP laparoscopic technique in emergency ventral hernia repair has not yet been reported.

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