Systematic Review of Economic Evaluation of Laparotomy versus Laparoscopy for Patients Submitted to Roux-en-Y Gastric Bypass

<div><p>Background</p><p>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).</p><p>Methods</p><p>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.</p><p>Results</p><p>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.</p><p>Conclusion</p><p>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.</p></div

Description of costs, health endpoints and results of studies.

<p>Source: Prepared by the authors from the selected studies.</p><p>*ICER, incremental cost-effectiveness ratio.</p

General characteristics of the studies selected.

<p>Source: Preparedbytheauthorsfromtheselectedstudies.</p

Mortality, complications, surgical cost, days of hospitalization and return to labor market of the studies selected.

<p>Source: Prepared by the authors from the selected studies.</p><p>*LGB = Laparoscopic Gastric Bypass,</p><p>**OGB = Open Gastric Bypass or Laparotomy,</p><p>***NR = Not Reported,</p><p>¥Average of surgical cost. (U$4,922.00±1,927.00 - laparoscopy and U$ 3,591.00±1,000.00 - laparotomy)</p

Critical evaluation of the studies selected.

<p>Source: Prepared by the authors from the selected studies.</p><p>*BMI = Body Mass Index,</p><p>**RYGB = Roux-en-Y Gastric Bypass.</p

Flowchart.

<p>Flowchart.</p

Variation of Binge Eating One Year after Roux-en-Y Gastric Bypass and Its Relationship with Excess Weight Loss

<div><p>Background</p><p>Bariatric surgery is the most effective treatment for obesity classes II and III. However, some patients do not get the desired results or initially lose and then regain the lost weight. Identifying these individuals early on and treating them adequately remains a challenge. As binge eating directly affects food intake, the study of this symptom and its relation to bariatric surgery and its results is increasing, because it appears to have an influence on the results of surgery.</p><p>Objectives</p><p>This study aimed to see how binge eating changes, measured with the Binge Eating Scale, interferes in the % excess weight loss one year after Roux-en-Y gastric bypass.</p><p>Methods</p><p>We conducted a cross-sectional study with 149 patients older than 18 years who were evaluated one year after undergoing Roux-en-Y gastric bypass. The variation in the intensity of binge eating was measured with the pre- and postoperative Binge Eating Scale scores.</p><p>Results</p><p>The variation of one unit in the Binge Eating Scale implied an inverse variation of 0.41% of % excess weight loss (p<0.05). The correlation coefficient between the variation of binge eating and the % excess weight loss was -0.186 (p = 0.033). The correlation coefficient between the binge eating symptoms one year after surgery and the % excess weight loss was -0.353 (p<0.001).</p><p>Conclusions</p><p>There was a correlation between the variation of binge eating one year after gastric bypass and the % excess weight loss. The correlation between binge eating and the % excess weight loss was greater after the surgery than it was at the preoperative stage. This study provides new, valuable information on the intensity and variation of binge eating symptoms one year after gastric bypass, which, to the best of our knowledge, have not been studied in depth earlier.</p></div

Characteristics of the patients in our study.

<p>Characteristics of the patients in our study.</p

Correlation between BES and %EWL in the preoperative stage and one year after surgery.

<p></p><p></p><p></p><p>A BES score in the preoperative stage and its correlation with %EWL. rs = -0.124 p = 0.156</p><p></p><p></p><p>B BES score one year after surgery and its correlation with %EWL. rs = -0.353 p<0.001</p><p></p><p></p> %EWL, % of excess weight loss; Delta BES, BES at one year - preoperative BES; rs = correlation coefficient.<p></p> <p>A BES score in the preoperative stage and its correlation with %EWL. rs = -0.124 p = 0.156</p> <p>B BES score one year after surgery and its correlation with %EWL. rs = -0.353 p<0.001</p

Correlation between the variation of BE (Delta BES) and %EWL.

<p></p><p></p><p></p><p>A Correlation coefficient between %EWL and Delta BES and the distribution of the entire sample. rs = -0.186 p = 0.033</p><p></p><p></p><p>B Correlation coefficient and distribution of patients who had a negative Delta BES. rs = -0.101 p = 0.306</p><p></p><p></p><p>C Correlation coefficient and distribution of patients who had a positive Delta BES. rs = -0.378 p = 0.122</p><p></p><p></p> %EWL, % of excess weight loss; Delta BES, BES at one year—preoperative BES; rs, correlation coefficient.<p></p> <p>A Correlation coefficient between %EWL and Delta BES and the distribution of the entire sample. rs = -0.186 p = 0.033</p> <p>B Correlation coefficient and distribution of patients who had a negative Delta BES. rs = -0.101 p = 0.306</p> <p>C Correlation coefficient and distribution of patients who had a positive Delta BES. rs = -0.378 p = 0.122</p