Implementing laparoscopy in Brazil´s National Public Health System: the bariatric surgeons´ point of view

Abstract

BackgroundAlthough Brazilian National Public Health System (BNPHS) has presented advances regarding the treatment for obesity in the last years, there is a repressed demand for bariatric surgeries in the country. Despite favorable evidences to laparoscopy, the BNPHS only performs this procedure via laparotomy.Aim1) Estimate whether bariatric surgeons would support the idea of incorporating laparoscopic surgery in the BNPHS; 2) If there would be an increase in the total number of surgeries performed; 3) As well as how BNPHS would redistribute both procedures.MethodsA panel of bariatric surgeons was built. Two rounds to answer the structured Delphi questionnaire were performed.ResultsFrom the 45 bariatric surgeons recruited, 30 (66.7%) participated in the first round. For the second (the last) round, from the 30 surgeons who answered the first round, 22 (48.9%) answered the questionnaire. Considering the possibility that BNPHS incorporated laparoscopic surgery, 95% of surgeons were interested in performing it. Therefore, in case laparoscopic surgery was incorporated by the BNPHS there would be an average increase of 25% in the number of surgeries and they would be distributed as follows: 62.5% via laparoscopy and 37.5% via laparotomy.Conclusion1) There was a preference by laparoscopy; 2) would increase the number of operations compared to the current model in which only the laparotomy is available to users of the public system; and 3) the distribution in relation to the type of procedure would be 62.5% and 37.5% for laparoscopy laparotomy.

What is the major public health problem: the morbid obesity or the bariatric surgery in the unified health system? (Part II)

“…Six years later, through Ordinance on 425 of 19 March 2013, the Ministry of Health determined, among other things, the human resources and infrastructure for the adequacy and registration of the "High Complexity Center for Patients with Obesity" 11 . Brazil has now 78 units authorized by the Ministry of Health (MOH) in 20 different states 12 . Despite various guidelines and imposed bureaucratic regulations, the system offers little or no financial or training encouragement to the staff.…”