RESUMO

BACKGROUND: Although Brazilian National Public Health System (BNPHS) has presented advances regarding the treatment for obesity in the last years, there is a repressed demand for bariatric surgeries in the country. Despite favorable evidences to laparoscopy, the BNPHS only performs this procedure via laparotomy. AIM: 1) Estimate whether bariatric surgeons would support the idea of incorporating laparoscopic surgery in the BNPHS; 2) If there would be an increase in the total number of surgeries performed; 3) As well as how BNPHS would redistribute both procedures. METHODS: A panel of bariatric surgeons was built. Two rounds to answer the structured Delphi questionnaire were performed. RESULTS: From the 45 bariatric surgeons recruited, 30 (66.7%) participated in the first round. For the second (the last) round, from the 30 surgeons who answered the first round, 22 (48.9%) answered the questionnaire. Considering the possibility that BNPHS incorporated laparoscopic surgery, 95% of surgeons were interested in performing it. Therefore, in case laparoscopic surgery was incorporated by the BNPHS there would be an average increase of 25% in the number of surgeries and they would be distributed as follows: 62.5% via laparoscopy and 37.5% via laparotomy. CONCLUSION: 1) There was a preference by laparoscopy; 2) would increase the number of operations compared to the current model in which only the laparotomy is available to users of the public system; and 3) the distribution in relation to the type of procedure would be 62.5% and 37.5% for laparoscopy laparotomy.

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BACKGROUND: Because of the high prevalence of obesity, there is a growing demand for bariatric surgery worldwide. The objective of this systematic review was to analyze the difference in relation to cost-effectiveness of access route by laparoscopy versus laparotomy of Roux en-Y gastric bypass (RYGB). METHODS: A systematic review was conducted in the electronic databases MEDLINE, Embase, Scopus, Cochrane and Lilacs in order to identify economic evaluation studies that compare the cost-effectiveness of laparoscopic and laparotomic routes in RYGB. RESULTS: In a total of 494 articles, only 6 fulfilled the eligibility criteria. All studies were published between 2001 and 2008 in the United States (USA). Three studies fulfilled less than half of the items that evaluated the results quality; two satisfied 5 of the required items, and only 1 study fulfilled 7 of 10 items. The economic evaluation of studies alternated between cost-effectiveness and cost-consequence. Five studies considered the surgery by laparoscopy the dominant strategy, because it showed greater clinical benefit (less probability of post-surgical complications, less hospitalization time) and lower total cost. CONCLUSION: This review indicates that laparoscopy is a safe and well-tolerated technique, despite the costs of surgery being higher when compared with laparotomy. However, the additional costs are compensated by the lower probability of complications after surgery and, consequently, avoiding their costs.

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RESUMO

BACKGROUND: Although Brazilian National Public Health System (BNPHS) has presented advances regarding the treatment for obesity in the last years, there is a repressed demand for bariatric surgeries in the country. Despite favorable evidences to laparoscopy, the BNPHS only performs this procedure via laparotomy. AIM: 1) Estimate whether bariatric surgeons would support the idea of incorporating laparoscopic surgery in the BNPHS; 2) If there would be an increase in the total number of surgeries performed; 3) As well as how BNPHS would redistribute both procedures. METHODS: A panel of bariatric surgeons was built. Two rounds to answer the structured Delphi questionnaire were performed. RESULTS: From the 45 bariatric surgeons recruited, 30 (66.7%) participated in the first round. For the second (the last) round, from the 30 surgeons who answered the first round, 22 (48.9%) answered the questionnaire. Considering the possibility that BNPHS incorporated laparoscopic surgery, 95% of surgeons were interested in performing it. Therefore, in case laparoscopic surgery was incorporated by the BNPHS there would be an average increase of 25% in the number of surgeries and they would be distributed as follows: 62.5% via laparoscopy and 37.5% via laparotomy. CONCLUSION: 1) There was a preference by laparoscopy; 2) would increase the number of operations compared to the current model in which only the laparotomy is available to users of the public system; and 3) the distribution in relation to the type of procedure would be 62.5% and 37.5% for laparoscopy laparotomy. .

RACIONAL: Nos últimos anos, apesar do Sistema Único de Saúde Brasileiro - SUS - apresentar avanços relacionados à organização e ampliação das ações voltadas à prevenção e ao tratamento da obesidade, existe demanda reprimida de operações no país. Mesmo com evidências favoráveis à operação por via laparoscópica, o SUS só permite o procedimento por via laparotômica. OBJETIVOS: 1) Estimar se os cirurgiões bariátricos apoiariam eventual incorporação da operação por via laparoscópica no SUS; 2) se haveria incremento no número total de operações caso houvesse esta nova opção de via de acesso; e 3) como seria a redistribuição da oferta de operações pelas duas vias. MÉTODOS: Com o método Delphi, foi construído um painel de especialistas, em que cirurgiões bariátricos responderam um questionário estruturado previamente desenvolvido para esse fim. Foram realizadas duas rodadas, no intuito de melhor consenso. RESULTADOS: Dos 45 cirurgiões que estiveram presentes no evento nacional, 30 (66,7%) participaram do questionário Delphi, o que correspondeu à primeira rodada do estudo. Na segunda, e última rodada, dos 30 respondentes da primeira etapa, 22 (48,9%) cirurgiões responderam. Mediante a possibilidade de incorporação da via laparoscópica no SUS, aproximadamente 95% dos cirurgiões manifestaram interesse em realizá-la. Caso a operação por laparoscopia fosse incorporada no SUS, haveria incremento médio no número de operações na ordem de 25%; nesta nova configuração, a oferta de procedimentos cirúrgicos estaria distribuída da seguinte forma: 62,5% por laparoscopia e 37,5% por laparotomia. CONCLUSÃO: ...

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