title: Systematic review of economic evaluation of laparotomy versus laparoscopy for patients submitted to Roux-en-Y gastric bypass.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Samanta Pereira
authors.initials: SP
authors.lastname: Sussenbach
authors.affiliation: Faculdade de Ceilândia da Universidade de Brasília, Brasília, Brasil.
authors.forename: Everton Nunes
authors.initials: EN
authors.lastname: Silva
authors.affiliation: 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.
authors.forename: Milene Amarante
authors.initials: MA
authors.lastname: Pufal
authors.affiliation: Centro da Obesidade e Síndrome Metabólica do Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (COM HSL-PUCRS), Porto Alegre, Brasil; Postgraduate Program in Medical Sciences: Endocrinology and Metabolism, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Port Alegre, Porto Alegre, Brazil.
authors.forename: Daniela Shan
authors.initials: DS
authors.lastname: Casagrande
authors.affiliation: 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.
authors.forename: Alexandre Vontobel
authors.initials: AV
authors.lastname: Padoin
authors.affiliation: 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.
authors.forename: Cláudio Corá
authors.initials: CC
authors.lastname: Mottin
mesh_terms: D015992:Body Mass Index; D003362:Cost-Benefit Analysis; D015390:Gastric Bypass / Q000191:economics*; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D007813:Laparotomy / Q000191:economics* / Q000379:methods; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D009767:Obesity, Morbid / Q000191:economics* / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D015431:Weight Loss