Cost-effective restrictive bariatric surgery: laparoscopic vertical banded gastroplasty versus laparoscopic adjustable gastric band.
BACKGROUND
Among bariatric restrictive operations, the procedure of choice is still controversial. The aim of this study is to compare the cost of two gastric restrictive procedures: laparoscopic vertical banded gastroplasty (LVBG) and laparoscopic adjustable gastric banding (LAGB).


METHODS
This is a prospective nonrandomized study comparing the cost effectiveness of LVBG and LAGB. Fifty-nine LVBG are compared to 83 LAGB performed during the same period, September 2005 and August 2006. Both groups demonstrate similar body mass index range and gender distribution.


RESULTS
Cost analysis is evaluated as: preoperative, intraoperative, postoperative, follow-up, and management of complication cost. Both groups have similar preoperative and immediate postoperative cost. The material cost for LVBG is significantly lower than for LAGB ($1,326.42 for LVBG to $3,253.42 for LAGB). This material cost, however, excludes instruments and materials that are used in both procedures. Although both groups have similar postoperative routine visits, LAGB visits require band fills which increase its cost by $28 if fills are by palpation or $179 if by ultrasound. The complications in LAGB were also more severe with four patients returning to the operating room and another one medically managed for pulmonary embolism. These are at a higher cost compared to LVBG where none of the patients require reoperation or readmissions. The rate of percentage excess weight loss in LVBG patients however is more rapid than in LAGB patients.


CONCLUSIONS
LVBG required less expensive instruments and materials for the operation and was associated with a higher rate of weight loss and less complications.
Ojo
Peter
P
Department of Surgery, Hospital of Saint Raphael, 1450 Chapel Street, New Haven, CT 06511, USA. petfunmiojo@yahoo.co.uk
Valin
Elmer
E
D000328:Adult; D015992:Body Mass Index; D003362:Cost-Benefit Analysis; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000191:economics / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000191:economics* / Q000601:surgery*; D011183:Postoperative Complications / Q000191:economics* / Q000453:epidemiology; D011300:Preoperative Care / Q000191:economics; D011446:Prospective Studies; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult