RESUMO
With the development of interventional radiology and endoscopy, the practice of inserting expandable metallic stents for malignant jaundice has become widespread. Many studies have compared surgical bypass with polyethylene stents, or metallic stents with polyethylene stents. However, few data are available on the comparison of surgical bypass and metallic stents. The aim of this study was to compare the patient's postprocedure course and the cost performance of surgical bypass and metallic stents in patients with unresectable pancreatic cancer. The parameters analyzed were the rates of procedural and therapeutic success, duration of hospital stay, prevalence of early and late complications, cost performance, and prognosis. The rates of procedural and therapeutic success were excellent with both palliative treatments. With surgical bypass, there was a low prevalence of late complications, but duodenal obstruction sometimes occurred in patients without gastric bypass. With metallic stents, there was shorter hospitalization and lower cost, but a higher prevalence of late complications. Stent occlusion tended to occur in patients with uncovered metallic stents. There was no difference in the prognosis between the two palliative treatments. Thus, in consideration of the poor prognosis of pancreatic cancer, in patients with unresectable pancreatic cancer, insertion of covered metallic stents would be preferable to surgical bypass, because of the subsequent short hospitalization and the low cost. On the other hand, in patients with a relatively long expected prognosis, or in those with existing duodenal obstruction, biliary bypass with gastrojejunostomy may provide an advantage.
Assuntos
Ligas/efeitos adversos , Ligas/economia , Desvio Biliopancreático/efeitos adversos , Desvio Biliopancreático/economia , Cuidados Paliativos/economia , Neoplasias Pancreáticas/cirurgia , Implantação de Prótese/efeitos adversos , Implantação de Prótese/economia , Stents/efeitos adversos , Stents/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Desvio Biliopancreático/mortalidade , Obstrução Duodenal/economia , Obstrução Duodenal/etiologia , Obstrução Duodenal/mortalidade , Feminino , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/economia , Neoplasias Pancreáticas/mortalidade , Complicações Pós-Operatórias , Prognóstico , Implantação de Prótese/mortalidade , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: The reason for this inquiry was to assess the actual state of Bariatric Surgery in Germany, especially relating to the much discussed economic aspect. METHOD: A questionnaire was sent to those hospitals in Germany in which we knew that obesity surgery was performed, concerning the year 1997. RESULTS: To our regret, the feedback was only 37%, although this must be considered an adequate response for Germany. Nevertheless, some interesting trends are easily seen. CONCLUSION: Bariatric Surgery in Germany could pay for itself by saving the costs associated with conservative therapy and preventing co-morbidities in patients with morbid obesity.
