Laparoscopic single-incision gastric bypass: initial experience, technique and short-term outcomes

Annals of Surgical Innovation and Research

Ivan Alberto Zepeda Mejia²  Tomasz Rogula¹ 

[1] Cleveland Clinic, Bariatric and Metabolic Institute, 9500 Euclid Ave, M66-06, Cleveland 44118, OH, USA

[2] Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

关键词: Morbid obesity;    Cosmesis;    Post-operative Pain;    Bariatric surgery;    Single incision gastric bypass;    Single incision laparoscopic surgery;   

Others  :  1234938
DOI  :  10.1186/s13022-015-0016-z

 received in 2015-05-20, accepted in 2015-10-06,  发布年份 2015

【 摘 要 】

Background

Single incision laparoscopic surgery (SILS) research has been limited. The aim of this study is to describe our technique and to evaluate the short term outcomes and efficacy of SILS Roux-en-Y gastric bypass (RYGB) in a selected group of patients in a single center.

Methods

From March 2012 to January 2013, a total of fourteen patients underwent SILS RYGB using a single vertical 2.5–3 cm intra-umbilical incision, 3-ports placed trans-fascially, and a liver suspension technique in Cleveland Clinic’s Bariatric & Metabolic Institute, in Cleveland, Ohio, USA. Patient selection, short-term outcomes and technical issues were retrospectively viewed in this study.

Results

A total of 14 morbid obese patients (12 women and 2 men; mean age, 46 years). Mean operative time was 196 (range 131–265) min. Mean weight at surgery was 113 (range 91–135) kg. One patient required placement of one additional port (7 %). No conversions to conventional laparoscopic surgery (CLS) or open surgery was needed. The estimated blood loss was 40 (range 20–100) ml. In terms of pain control, the frequency of patient controlled analgesia had a mean use of 21 times in postoperative day 0 (POD), 37 times in POD1 and 13 times in POD2. Pain score (assessed by visual analogue scale) had a median score of 6.9 in POD0, 5.2 In POD1 and 3.8 in POD2. Weight loss was approximately 7.25 lb. (±4.5) after first postoperative visit, 28.9 lb. (±11.86) after 1 month and 45.4 lb. (±15.4) after 4 months. No patients required re-operation or readmission during the 90 days after surgery.

Conclusion

Single incision is feasible, safe and reproducible technique used as an access to complex surgeries like gastric bypass in carefully selected patients. Results in short-term outcomes are comparable to those observed in literature. Some potential benefits include less postoperative pain, improved cosmesis, and patient satisfaction. Randomized trials involving larger patient series with a longer follow-up and larger cohort studies and/or systematic reviews will be necessary to assess the extent of the benefits and limitations of SILS in bariatric surgery.

【 授权许可】

   
2015 Zepeda Mejia and Rogula.

【 图 表 】

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【 参考文献 】

• [1]Reoch J, Mottillo S, Shimony A, et al. Safety of laparoscopic vs open bariatric surgery: A systematic review and meta-analysis. Arch Surg. 2011;146:1314–22.
• [2]Nguyen NT et al.. Strategic laparoscopic surgery for improved cosmesis in general and bariatric surgery: analysis of initial 127 cases. J Laparoendosc Adv Surg Tech A. 2012; 22:355-361.
• [3]Huang C-K, Lo C-H, Houng J-Y, Chen, Y-S, Lee P-H. Surgical results of single-incision transumbilical laparoscopic Roux-en-Y gastric bypass.Surg Obes Relat Dis. 2012;8:201–7.
• [4]Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11: S240–52.
• [5]Mittermair R, Pratschke J, Sucher R. Single-incision laparoscopic sleeve gastrectomy. Am Surg. 2013; 79:393-397.
• [6]Rogula T et al.. Laparoscopic bariatric surgery can be performed through a single incision: a comparative study. Obes Surg. 2014; 24:1102-1108.
• [7]Huang C-K et al.. A novel surgical technique: single-incision transumbilical laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2010; 20:1429-1435.
• [8]Varela JE. Single-site laparoscopic sleeve gastrectomy: preclinical use of a novel multi-access port device. Surg Innov. 2009; 16:207-210.
• [9]Fernández JI, Ovalle C, Farias C, de la Maza J, Cabrera C. Transumbilical laparoscopic Roux-en-Y gastric bypass with hand-sewn gastrojejunal anastomosis. Obes Surg. 2013; 23:140-144.
• [10]Merchant AM et al.. Transumbilical Gelport access technique for performing single incision laparoscopic surgery (SILS). J Gastrointest Surg. 2009; 13:159-162.
• [11]Koh CE, Martin DJ, Cavallucci DJ, Becerril-Martinez G, Taylor CJ. On the road to single-site laparoscopic adjustable gastric banding: lessons learned from 60 cases. Surg Endosc. 2011; 25:947-953.
• [12]Lakdawala MA, Muda NH, Goel S, Bhasker A. Single-incision sleeve gastrectomy versus conventional laparoscopic sleeve gastrectomy—a randomised pilot study. Obes Surg. 2011; 21:1664-1670.