Laparoscopic and Laparotomy Bariatric Surgery in a Public Hospital in Brazil: Are There Differences in Costs and Complications?

Abstract

BACKGROUND: Despite its increasing popularity, laparoscopy is not the option for bariatric surgeries performed in the Brazilian public health system. AIMS: To compare laparotomy and laparoscopic access in bariatric surgery, considering aspects such as morbidity, mortality, costs, and length of stay. METHODS: The study included 80 patients who were randomly assigned to perform a Roux-en-Y gastric bypass. They were equally divided in two groups, laparoscopic and laparotomy. The results obtained in the postoperative period were evaluated and compared according to the Ministry of Health protocol, and later, in their outpatient returns. RESULTS: The surgical time was similar in both groups (p=0.240). The costs of laparoscopic surgery proved to be higher, mainly due to staplers and staples. The patients included in the laparotomy group presented higher rates of severe complications, such as incisional hernia (p<0.001). Costs related to social security and management of postoperative complications were higher in the open surgery group (R$ 1,876.00 vs R$ 34,268.91). CONCLUSIONS: The costs related to social security and treatment of complications were substantially lower in laparoscopic access when compared to laparotomy. However, considering the operative procedure itself, the laparotomy remained cheaper. Finally, the length of stay, the rate of complications, and return to labor had more favorable results in the laparoscopic route.

Complicaciones transoperatorias y postoperatorias de la cirugía bariátrica. Una revisión sistemática

“…Las complicaciones agudas se pueden presentar durante la cirugía en el operatorio y en el postoperatorio, como, por ejemplo, las hemorragias que generan la necesidad de conversión de una cirugía laparoscopia o robótica a cirugía abierta. Las complicaciones a largo plazo incluyen; reflujo gastroesofágico y hernias abdominales estas últimas, son más frecuentes en la cirugía abierta en comparación con la laparoscópica, existiendo una variación de acuerdo con el procedimiento quirúrgico (13).…”