Sussenbach Samanta Pereira, Silva Everton Nunes, Pufal Milene Amarante, Casagrande Daniela Shan, Padoin Alexandre Vontobel, Mottin Cláudio Corá
Centro da Obesidade e Síndrome Metabólica do Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (COM HSL-PUCRS), Porto Alegre, Brasil; Pós-Graduação em Medicina e Ciências da Saúde da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
Faculdade de Ceilândia da Universidade de Brasília, Brasília, Brasil.
PLoS One. 2014 Jun 19;9(6):e99976. doi: 10.1371/journal.pone.0099976. eCollection 2014.
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).
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.
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.
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.
由于肥胖症的高患病率，全球对减肥手术的需求日益增长。本系统评价的目的是分析腹腔镜与开腹行Roux-en-Y胃旁路术（RYGB）在成本效益方面的差异。
在电子数据库MEDLINE、Embase、Scopus、Cochrane和Lilacs中进行系统评价，以识别比较腹腔镜和开腹途径在RYGB中成本效益的经济评价研究。
在总共494篇文章中，只有6篇符合纳入标准。所有研究均于2001年至2008年在美国发表。三项研究满足评估结果质量的项目不到一半；两项满足5项所需项目，只有1项研究满足10项中的7项。研究的经济评价在成本效益和成本后果之间交替。五项研究认为腹腔镜手术是主要策略，因为它显示出更大的临床益处（术后并发症概率更低、住院时间更短）和更低的总成本。
本评价表明，腹腔镜检查是一种安全且耐受性良好的技术，尽管与开腹手术相比手术成本更高。然而，额外的成本被手术后并发症概率降低所抵消，从而避免了相关成本。
