Authors' objectives:

To evaluate the safety and efficacy of laparoscopic techniques in intestinal and gynaecological surgery and their economic implications, at the request of French National health Insurance.

Authors' results and conclusions: Laparoscopy is indicated in cholecystectomy, gastroesophageal reflux, vagotomy, appendectomy, colorectal surgery and inguinal hernia surgery, endometriosis, hysterectomy, extrauterine pregnancy, tubal sterility, ovarian cysts. A number of studies demonstrated a decreased cost.

Authors' recommendations: The indications for cholecystectomy remain unchanged; prophylactic cholecystectomy is not justified. Laparoscopic cholecystectomy has certain advantages (decreased hospital stay, fewer complications, improved patient comfort). Special training is essential. Laparoscopy is of no benefit in appendectomy, except for diagnostic purposes in women. Certain forms of hernia repair can be performed by laparoscopy. Data concerning other indications is insufficient. Laparoscopic treatment of endometriosis gives a higher pregnancy rate than laparotomy, but further studies are required, especially concerning complications and quality of life. Laparoscopic hysterectomy allows a decreased hospital stay and less pain. Laparoscopy may be superior to laparotomy in terms of fertility after extrauterine pregnancy. No difference has been demonstrated for distal tubal sterility. Laparoscopic treatment of ovarian cysts is popular in France, although not based on randomized studies. Contrary to popular opinion, laparoscopy is not less expensive than conventional surgery and may even be more expensive in the short-term. Mass media and attending physicians have encouraged an increased demand for these techniques. Other output or dissemination activity: Covered by health insurers only for: cholecystectomy, extra uterine pregnancy, appendectomy for diagnostic purposes in women.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.has-sante.fr/

Year Published: 1994

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: France

Organisation Name: L'Agence Nationale d'Accreditation d'Evaluation en Santé

Contact Address: 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France. Tel: +33 01 55 93 71 88; Fax: +33 01 55 93 74 35;

Contact Name: sh.leerobin@has-sante.fr

Contact Email: sh.leerobin@has-sante.fr

Copyright: Agence Nationale pour le Developpement de l'Evaluation Medicale