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Presurgical Hidden Costs: Imaging, Assessment Clinic

  • Cristiano Sgrazzutti
  • Ilaria Vicentin
  • Alessandra Coppola
  • Angelo Vanzulli
Chapter

Abstract

The diagnosis of abdominal hernias is often made with only physical examination; however, in several cases radiological support is required. Nowadays, diagnostic tools used are mainly represented by Ultrasounds, Computed Tomography, and, in some complex case, Magnetic Resonance. To discuss the real costs of hernia diagnosis, in addition to purely economics features (reimbursement), some aspects must be taken into consideration such as the radiologist time (single operator for US/presence of technician for CT and MR), the possibility of performing a dynamic evaluation (Valsalva maneuver for US and MR or standing for US), and the employment of ionizing radiation (CT). At first evaluation, ultrasounds appear the less expensive diagnostic modality, but the operator dependency makes this diagnostic tool non-standardizable, leading often to further diagnostic tests, such as CT or MR in young patients, and in complex cases, increasing the expense rate. Cost analysis in medicine cannot be limited to an isolated diagnostic moment, but it might be considered an integrated diagnostic–therapeutic pathway, in order to make the most accurate diagnosis and the best treatment.

Keywords

Diagnostic imaging Hernia surgery Cost analysis 

References

  1. 1.
    Parikh KR, Al-Hawary M, Millet JD, Burney R, Finks J, Maturen K. Incisional hernia repair: what the radiologist needs to know. AJR Am J Roentgenol. 2017;209(6):1239–46.CrossRefGoogle Scholar
  2. 2.
    Bedewi MA, El-sharkawy M. Imaging of hernias, hernia fethi derbel. London: IntechOpen; 2017.Google Scholar
  3. 3.
    Rettenbacher T, Hollerweger A, Macheiner P, et al. Abdominal wall hernias: cross-sectional imaging signs of incarceration determined with sonography. AJR Am J Roentgenol. 2001;177:1061–6.CrossRefGoogle Scholar
  4. 4.
    Lassandro F, Iasiello F, Luisa Pizza N, Valente T, Stefano M, Luisa Mangoni di Santo Grassi R, et al. Abdominal hernias: radiological features. World J Gastrointest Endosc. 2011;3(6):110–7.CrossRefGoogle Scholar
  5. 5.
    Young J, Gilbert AI, Graham MF. The use of ultrasound in the diagnosis of abdominal wall hernias. Hernia. 2007;11(4):347–51.CrossRefGoogle Scholar
  6. 6.
    Munden MM, Trautwein LM. Scrotal pathology in pediatrics with sonographic imaging. Curr Probl Diagn Radiol. 2000;29:185–205.CrossRefGoogle Scholar
  7. 7.
    Shadbolt CL, Heinze SB, Dietrich RB. Imaging of groin masses: inguinal anatomy and pathologic conditions revisited. Radiographics. 2001;21:S261–71.CrossRefGoogle Scholar
  8. 8.
    Bradley M, Morgan J, Pentlow B, Roe A. The positive predictive value of diagnostic ultrasound for occult herniae. Ann R Coll Surg Engl. 2006;88(2):165–7.CrossRefGoogle Scholar
  9. 9.
    Jamadar DA, Jacobson JA, Girish G, Balin J, Brandon CJ, Caoili EM, et al. Abdominal wall hernia mesh repair: sonography of mesh and common complications. J Ultrasound Med. 2008;27:907–17.CrossRefGoogle Scholar
  10. 10.
    Aguirre DA, Santosa AC, Casola G, Sirlin CB. Abdominal wall hernias: imaging features, complications, and diagnostic pitfalls at multi–detector row CT. Radiographics. 2005;25:1501–20.CrossRefGoogle Scholar
  11. 11.
    Emby DJ, Aoun G. CT technique for suspected anterior abdominal wall hernia. Am J Roentgenol. 2003;181(2):431–3.CrossRefGoogle Scholar
  12. 12.
    Olmo JCM, García-vallejo L, Gestal JN, Coello PC, Antona FB, Trincado MT, et al. The usefulness of magnetic resonance imaging in the preoperative study and postoperative control in the laparoscopic treatment of the incisional hernia. Surg Sci. 2015;6:376–82.CrossRefGoogle Scholar
  13. 13.
    Salati U, Mansour E, Torreggiani W. True-FISP MRI in diagnosis of postoperative hernia recurrence: a brief report. Hernia. 2014;18(4):597–600.CrossRefGoogle Scholar
  14. 14.
    Langbach O, Holmedal SH, Grandal OJ, Røkke O. Adhesions to mesh after ventral hernia mesh repair are detected by MRI but are not a cause of long term chronic abdominal pain. Gastroenterol Res Pract. 2016;2016:2631598.CrossRefGoogle Scholar
  15. 15.
    Bendavid R. Complications of groin hernia surgery. Surg Clin North Am. 1998;78(6):1089–103.CrossRefGoogle Scholar
  16. 16.
    Nomenclatore dell’assistenza specialistica ambulatoriale [Internet]. Available from: http://www.salute.gov.it/portale/temi/p2_6.jsp?lingua=italiano&id=1767&area=programmazioneSanitariaLea&menu=lea

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Cristiano Sgrazzutti
    • 1
  • Ilaria Vicentin
    • 2
  • Alessandra Coppola
    • 2
  • Angelo Vanzulli
    • 1
  1. 1.RadiologyNiguarda HospitalMilanItaly
  2. 2.RadiologyUniversità degli Studi di Milano, Scuola di Specializzazione in RadiodiagnosticaMilanItaly

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