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Jiang Z, Zhang Z, Feng T, Cheng Y, Zhang G, Zhong M, Hu S. Trocar number and placement for laparoscopic sleeve gastrectomy and comparison of single-incision and conventional laparoscopic sleeve gastrectomy: a systematic review and meta-analysis. Int J Surg 2023; 109:1783-1795. [PMID: 37068794 PMCID: PMC10389429 DOI: 10.1097/js9.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/06/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Conventional laparoscopic sleeve gastrectomy (CLSG) has been conducted in multiple centers for treating morbid obesity, however, there are no standard criteria for (1) placing the trocar; and (2) how many trocars should be used. Single-incision laparoscopic sleeve gastrectomy (SLSG), a newly emerged technique in 2008, has been proposed as an alternative to CLSG in recent years, however, there is no definite evidence for this. MATERIALS AND METHODS A systematic literature search was performed using the PubMed, Embase, Web of Science, and Cochrane Library databases for laparoscopic sleeve gastrectomy cases from January 2006 to October 2022. We then summarized the trocar numbers and placement patterns among these studies. A meta-analysis was conducted to compare the difference between SLSG and CLSG in the perioperative and postoperative indices. RESULTS A total of 61 studies involving 20 180 patients who underwent laparoscopic sleeve gastrectomy for treating morbid obesity were included in the systematic review, including 11 on SLSG, 35 on CLSG, and 15 studies comparing SLSG and CLSG. A systematic review showed that the trocar number varied in different CLSG studies, mainly using four or five trocars. The trocars were mainly placed in position, presenting an inverted trapezoid pattern and a left-predominant pattern. Meta-analysis showed that the operative time in the SLSG was significantly higher than that in the CLSG, and the pain Visual Analog Scale rating on postoperative day 1 in the CLSG was significantly higher than in the SLSG. There were no statistical significances in the other complications or surgical efficiency. CONCLUSIONS In the CLSG, the majority of the trocars were arranged in an inverted trapezoid pattern and were of the left-predominant type. Although SLSG is a feasible technique in selected patients, there is insufficient evidence to recommend its widespread use compared with CLSG. High-quality randomized controlled trials with large study populations and long follow-up periods will be required in the future.
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Affiliation(s)
- Zhengchen Jiang
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
| | - Zhao Zhang
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
| | - Tianyi Feng
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
| | - Yugang Cheng
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Guangyong Zhang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Mingwei Zhong
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Sanyuan Hu
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
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Al Sabah S, Haddad EA, Shuaibi S, Qadhi I, Al-Saidan L, Khayat A. Long-term Outcomes of Sleeve Gastrectomy in Adolescent Patients: The Effect of Weight Loss in Younger Years to Outcomes in Adulthood. BMC Surg 2023; 23:103. [PMID: 37118797 PMCID: PMC10148482 DOI: 10.1186/s12893-023-02006-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 04/12/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Childhood obesity is associated with a variety of complications that see their light throughout adulthood. Due to the serious side effects of these morbidities, early intervention is essential. Laparoscopic sleeve gastrectomy (SG) is a safe and effective procedure for the treatment of obesity, however, the long-term data on its use in adolescents is lacking in the literature. METHODS A retrospective analysis was conducted on all patients that underwent SG aged between 12 and 21 years old at a public hospital in Kuwait. Data on their weight and comorbidities was collected and analyzed. RESULTS 164 adolescent patients with a mean age of 19 underwent SG. 71% of the patients were female, while the mean weight at surgery was 128.6 kg, corresponding to a BMI of 47.8 Kg/m2. 32% of patients had a starting BMI more than 50, while 6.7% had a BMI over 60. The highest weight loss was achieved at 18 months post-op, corresponding to an EWL of 82.66%. On long-term follow-up, weight loss was maintained over the 13 years post-op. Obstructive sleep apnea resolved in 75% of the patients while hypertension persisted in the 2 patients who were diagnosed with it pre-op. 21 patients developed gastro-esophageal reflux disease 5.7 years post-op, while 20 patients were treated for gall bladder stones 4.4 years post-op. CONCLUSION It is of ample importance to tackle obesity during childhood before complications ensue later in life. Bariatric surgery, specifically SG, has been found to be an effective and safe weight loss tool, with sustained long-term weight maintenance and resolution of early comorbidities.
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Affiliation(s)
- Salman Al Sabah
- Department of Surgery, Kuwait University, Kuwait City, Kuwait.
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Symmetric three-port laparoscopic Roux-en-Y gastric bypass: a novel technique that is safe, effective, and feasible. Surg Today 2023; 53:702-708. [PMID: 36737497 DOI: 10.1007/s00595-022-02629-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/21/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE Single-incision laparoscopic surgery (SILS) has been validated as a safe approach for bariatric surgery. However, as the utilization of SILS in bariatric surgery is still limited by its disadvantages, this study analyzes the outcomes of symmetric three-port laparoscopic Roux-en-Y gastric bypass (STLGB). METHODS The medical records of patients who underwent STLGB between January 2018 and February 2021 were analyzed retrospectively using an institutional database. The patients were divided into four groups according to their baseline body mass index (BMI). The primary endpoints were operative time, length of stay, complication rate, and weight loss 12 months after surgery. RESULTS We analyzed the records of 101 patients who underwent STLGB. There was a slight predominance of women (n = 61; 60.4%). The mean operative time was 97.16 ± 38.79 min and the length of stay in the hospital after surgery was 2.79 ± 1.4 days. One patient (0.99%) suffered a gastrojejunal anastomosis leak within 30 days of surgery. There were no significant differences in LOS, complication rate, or cosmetic score among the four groups. The mean BMI reduction was 8.67 kg/m2 and the % total weight loss (%TWL) was 24.37%. Weight loss measured 12 months after surgery was significantly different among the four groups. CONCLUSIONS STLGB is safe, effective, and feasible for all kinds of patients. It is reproducible with standardization of the procedure.
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COMPUTED TOMOGRAPHY ASSESSMENT OF POSTOPERATIVE GASTRIC VASCULAR SUPPLY AND STAPLE-LINE LEAK DEVELOPMENT AFTER SLEEVE GASTRECTOMY. Surg Obes Relat Dis 2022; 18:812-819. [DOI: 10.1016/j.soard.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/05/2022] [Accepted: 03/26/2022] [Indexed: 11/23/2022]
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Prevention of incisional hernia after single-port sleeve gastrectomy (PRISM): a prospective non-randomized controlled study. Surg Endosc 2022; 36:7225-7232. [PMID: 35142904 DOI: 10.1007/s00464-022-09088-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND SPSG carries a risk of incisional hernia, particularly in patients with high body mass index. Prophylactic mesh placement with either permanent or absorbable mesh could decrease the occurrence of incisional hernia, with uncertainty on other postoperative parietal complications. METHODS This is a non-randomized monocentric single-blinded prospective study. High-risk patients (body mass index ≥ 45 kg/m2) underwent either 3 strategies of parietal closure (suture with or without permanent or absorbable mesh) during SPSG. The primary outcome was the occurrence of radiologically defined incisional hernia during the first postoperative year. Secondary outcomes included surgical site infection rates and postoperative pain. RESULTS Between November 2018 and November 2019, 255 patients were included (85 in each group). All patients reached one-year postoperative follow-up. Significantly more incisional hernias were observed in the no mesh group in comparison with permanent and absorbable mesh groups, respectively (20% vs. 7.1% vs. 5.1%, P = 0.005). No difference was observed in mesh groups. No difference was observed regarding other parietal complications. One patient in the absorbable mesh group presented a superficial surgical site infection and required surgical drainage without mesh removal and one patient in the permanent mesh group presented a parietal hematoma and required surgical drainage with mesh removal. Twenty-six (92.8%) asymptomatic patients presented incisional hernia discovered on the one-year CT-scan. CONCLUSIONS Prophylactic mesh placement during SPSG decreases the occurrence of postoperative incisional hernia. Routine permanent mesh placement could be proposed in high-risk patients.
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Safety and effectiveness of reduced-port laparoscopic sleeve gastrectomy in Asian morbidly obese patients. Sci Rep 2021; 11:23511. [PMID: 34873253 PMCID: PMC8648717 DOI: 10.1038/s41598-021-02999-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/24/2021] [Indexed: 12/04/2022] Open
Abstract
Laparoscopic sleeve gastrectomy is the most frequently performed surgical intervention in patients with morbid obesity. Single-port sleeve gastrectomy (SPSG) and reduced-port sleeve gastrectomy (RPSG) are increasingly reported in the literature. This study compared the short-term outcomes of SPSG, RPSG, and conventional laparoscopic sleeve gastrectomy (CLSG). This is a single-center retrospective study of 238 morbidly obese patients, of whom 148 (62.2%) patients completed follow-up one year after surgery. Propensity score matching was performed on factors influencing the choice of approach, and fifty patients from the SPSG + RPSG and CLSG groups were successfully matched. The groups were comparable in postoperative weight loss, morbidity, pain, and resolution of obesity-related comorbidities. The percentage of excess weight loss after one year was 90.0% in the SPSG + RPSG group and 75.2% in the CLSG group (P < 0.001). Complication rates showed no significant difference. The CLSG group was superior in dyslipidemia remission (17 [37.0%] vs. 28 [63.6%], P = 0.018) in the total cohort; however, this difference disappeared after matching. Our results suggest that single-port and reduced-port approaches could be alternative choices for selected patients. As our study was limited by its retrospective nature and potential selection bias, further studies are necessary to set standardized guidelines for SPSG.
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Gaillard M, Lainas P, Agostini H, Dagher I, Tranchart H. Impact of the calibration bougie diametre during laparoscopic sleeve gastrectomy on the rate of postoperative staple-line leak (BOUST): study protocol for a multicentre randomized prospective trial. Trials 2021; 22:806. [PMID: 34781991 PMCID: PMC8591884 DOI: 10.1186/s13063-021-05734-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/20/2021] [Indexed: 12/02/2022] Open
Abstract
Background Laparoscopic sleeve gastrectomy (LSG) has become an increasing bariatric procedure. The basic principle is to create a narrow stomach along the lesser curvature, using a calibration bougie as a template to perform a vertical partial gastrectomy, resecting the greater curvature and fundus of the stomach. The most common postoperative complication is gastric leak from the staple line, observed in approximately 3% of cases, which can result in long and incapacitating treatment. The diametre of the bougie used to calibrate the remnant stomach could impact the rate of postoperative gastric leak, a higher diametre being correlated with a lower risk of leak, without lowering long-term weight loss. This is the first randomized trial to compare the outcomes of LSG regarding the use of two different bougie diametres on postoperative gastric leak and mid-term weight loss. Methods Bougie Sleeve Trial (BOUST) is a superiority single-blinded randomized national trial, involving 17 centres. Participants will be randomized into two groups. LSG will be performed using a 48-Fr diametre calibration bougie in the experimental group and a standard care (34 to 38-Fr diametre) calibration bougie in the control group. Both groups will take part in a 2-year postoperative follow-up to assess postoperative gastric leak rate and weight loss and quality of life evolution. Discussion This study protocol will allow the investigators to determine if the use of a larger calibration bougie during LSG is associated with lower postoperative gastric leak occurrence without impairing mid-term weight loss and quality of life. The results of this trial will provide important data on patient safety and promote best practice for LSG procedures. Trial registration ClinicalTrials.govNCT02937649. Registered on 18 October 2016 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05734-3.
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Affiliation(s)
- Martin Gaillard
- Department of Minimally Invasive Digestive Surgery, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, 157 rue de la Porte de Trivaux, 92140, Clamart, France.,Faculté de Médecine Paris-Sud, Université Paris-Saclay, Orsay, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, 157 rue de la Porte de Trivaux, 92140, Clamart, France.,Faculté de Médecine Paris-Sud, Université Paris-Saclay, Orsay, France
| | - Hélène Agostini
- Department of Biostatistics and Clinical Research, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, 157 rue de la Porte de Trivaux, 92140, Clamart, France.,Faculté de Médecine Paris-Sud, Université Paris-Saclay, Orsay, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Hôpital Antoine Béclère, AP-HP, Université Paris-Saclay, 157 rue de la Porte de Trivaux, 92140, Clamart, France. .,Faculté de Médecine Paris-Sud, Université Paris-Saclay, Orsay, France.
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Lainas P, Derienne J, Zervaki S, Del Basso C, Malerba V, Devaquet N, Tranchart H, Dagher I. Left Hypochondrium or Transumbilical Single-Incision Laparoscopic Sleeve Gastrectomy for the Treatment of Severe Obesity: Surgical Technique and Results of a Tertiary Referral Bariatric Center. Obes Surg 2021; 31:5063-5070. [PMID: 34480332 DOI: 10.1007/s11695-021-05563-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/15/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Technical aspects of single-incision laparoscopic sleeve gastrectomy (SILSG) vary depending on surgeon's experience and availability of surgical equipment. We have performed more than 3000 SILSGs using standardized technique with left hypochondrium or transumbilical access. The aim of this study is to describe the SILSG technique in a stepwise manner providing technical tips and pitfalls for a left hypochondrium or transumbilical approach and report results of SILSG experience in a tertiary referral bariatric center. METHODS A detailed description of left hypochondrium and transumbilical SILSG is provided. Data from all consecutive patients who underwent SILSG between August 2010 and August 2017 were prospectively collected and retrospectively analyzed and reported. RESULTS One thousand eight hundred patients underwent SILSG, from which 384 (21.3%) using a transumbilical approach. Mean age was 42.3 years, median BMI 45.3 kg/m2, and median operative time 88 min. An additional port was required in 89 patients (4.9%). Postoperative mortality and morbidity rates were 0.05% and 7.5%, respectively. Relaparoscopy and/or endoscopic treatment were required for intra-abdominal bleeding in 27 patients (1.5%) and staple-line leakage in 35 patients (1.9%). Mean excess weight losses were 71.1%, 73.7%, and 70.4% at 1, 2, and 4 years after SILSG, respectively. Two years after SILSG, sustained statistical significant remission of major obesity-related comorbidities was noted. Incisional hernia occurred in 39 patients (2.1%). CONCLUSIONS The use of specific instruments allows standardization of left hypochondrium SILSG, which can be routinely performed for the treatment of severe obesity. Transumbilical approach for SILSG should be reserved for well-selected patients and experienced bariatric surgeons.
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Affiliation(s)
- Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140, Clamart, France. .,Paris-Saclay University, F-91405, Orsay, France.
| | - Joseph Derienne
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140, Clamart, France
| | - Styliani Zervaki
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140, Clamart, France.,Paris-Saclay University, F-91405, Orsay, France
| | - Celeste Del Basso
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140, Clamart, France.,Paris-Saclay University, F-91405, Orsay, France
| | - Valentina Malerba
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140, Clamart, France.,Paris-Saclay University, F-91405, Orsay, France
| | - Niaz Devaquet
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140, Clamart, France.,Paris-Saclay University, F-91405, Orsay, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140, Clamart, France.,Paris-Saclay University, F-91405, Orsay, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140, Clamart, France.,Paris-Saclay University, F-91405, Orsay, France
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Du D, Wang L, Sang Q, Zheng X, Lian D, Zhang N. Outcome Analysis of Single-Incision Trans-Umbilical Laparoscopic Sleeve Gastrectomy in Obese Chinese Adolescents. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dexiao Du
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Liang Wang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Qing Sang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Xuejing Zheng
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Dongbo Lian
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Nengwei Zhang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, China
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10
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Bikini Line Sleeve Gastrectomy: the First Experience in Europe. Obes Surg 2021; 31:3320-3323. [PMID: 33759108 DOI: 10.1007/s11695-021-05348-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
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Computed Tomography Assessment of Fat Distribution and Staple-Line Leak Risk After Sleeve Gastrectomy. Obes Surg 2021; 31:2011-2018. [PMID: 33409967 DOI: 10.1007/s11695-020-05199-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Sleeve gastrectomy (SG) has become the most frequent bariatric procedure and staple-line leak represents its most feared complication. Visceral obesity, a core component of the metabolic syndrome, has been associated with worst postoperative outcomes after various abdominal surgical procedures, and can be estimated by computed tomography (CT). The aim of this study was to assess the impact of radiologically determined visceral obesity in the risk of staple-line leak after SG. MATERIAL AND METHODS A retrospective analysis of a prospective database was performed in consecutive patients undergoing SG. Several anthropometric variables were measured on a preoperative CT scan. Multivariate analysis was performed to determine preoperative risk factors for staple-line leak. RESULTS During the study period, 377 patients were included in the analysis. The median BMI was 39.7 kg/m2 (36.5-43.5) and 8 patients (2.1%) presented a gastric leak. After multivariate analysis, visceral obesity defined by visceral fat area (VFA)/body surface area (BSA) ≥ 85 cm2/m2 was the only independent predictive factor for gastric leak (OR = 5312). CONCLUSION CT scan-assessed visceral obesity defined by a VFA/BSA ratio ≥ 85 cm2/m2 is associated with an increased risk of gastric leak after SG. Preoperatively radiological examination in patients suspected of visceral obesity would be useful to optimize preoperative management.
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Lainas P, De Filippo G, Di Giuro G, Mikhael R, Bougneres P, Dagher I. Laparoscopic Sleeve Gastrectomy for Adolescents Under 18 Years Old with Severe Obesity. Obes Surg 2020; 30:267-273. [PMID: 31520302 DOI: 10.1007/s11695-019-04150-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) is a widely accepted stand-alone bariatric operation. Data on adolescent patients undergoing LSG are limited. The aim of this study was to demonstrate that LSG is safe and effective for patients strictly under 18 years old with severe obesity. METHODS Prospectively collected data from consecutive patients undergoing LSG were retrospectively analyzed. Patients with more than 1-year follow-up were included in the analysis for weight loss and comorbidity evaluation. Quality of life (QoL) was evaluated using the Short-Form 36 questionnaire. RESULTS Eighty-four patients under 18 years old (range: 15-17 years) underwent LSG. Median weight was 128 kg and median body mass index (BMI) 43.7 kg/m2. Median duration of surgery was 68.5 min. One major complication was recorded: a patient developed severe pneumonia that necessitated ventilatory support in intensive care unit and intravenous antibiotic treatment. Mortality was null. Median length of hospital stay was 4 days. Six, 12, and 24 months after LSG, median BMI decreased significantly to 34.3, 29.8, and 28.8 kg/m2, respectively (p < 0.001), with a mean percentage of total body weight loss of 29.1% at 2 years. Obesity-related comorbidities improved at 1 year, while all SF-36 scale scores of QoL assessment improved significantly. CONCLUSION This study suggests that LSG is safe and effective for patients under 18 years old, resulting in significant weight loss, comorbidity remission, and QoL improvement. Careful patient selection after adequate risk versus benefit evaluation by an expert multidisciplinary team is essential.
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Affiliation(s)
- Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Assistance Publique - Hôpitaux de Paris, 92140, Clamart, France. .,Paris-Saclay University, 91405, Orsay, France.
| | - Gianpaolo De Filippo
- Department of Adolescent Medicine, Bicetre Hospital, Assistance Publique - Hôpitaux de Paris, 94270, Le Kremlin-Bicêtre, France.,French Clinical Research Group in Adolescent Medicine and Health, Paris, France
| | - Giuseppe Di Giuro
- Department of Digestive Surgery, Orsay Hospital, 91400, Orsay, France
| | - Rabih Mikhael
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Assistance Publique - Hôpitaux de Paris, 92140, Clamart, France
| | - Pierre Bougneres
- Department of Adolescent Medicine, Bicetre Hospital, Assistance Publique - Hôpitaux de Paris, 94270, Le Kremlin-Bicêtre, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Assistance Publique - Hôpitaux de Paris, 92140, Clamart, France.,Paris-Saclay University, 91405, Orsay, France
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13
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Gaillard M, Tranchart H, Beaudreuil S, Lebrun A, Voican CS, Lainas P, Courie R, Perlemuter G, Parier B, Hammoudi Y, Durrbach A, Dagher I. Laparoscopic sleeve gastrectomy for morbid obesity in renal transplantation candidates: a matched case-control study. Transpl Int 2020; 33:1061-1070. [PMID: 32396658 DOI: 10.1111/tri.13637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/27/2020] [Accepted: 05/06/2020] [Indexed: 12/20/2022]
Abstract
Obesity has become an important issue in patients with end-stage renal disease (ESRD). Since it is considered a relative contraindication for renal transplantation, bariatric surgery has been advocated to treat morbid obesity in transplant candidates, and laparoscopic sleeve gastrectomy (LSG) is the most reported procedure. However, comparative data regarding outcomes of LSG in patients with or without ESRD are scarce. Consecutive patients with ESRD (n = 29) undergoing LSG were compared with matched patients with normal renal function undergoing LSG in a 1:3 ratio using propensity score adjustment. Data were collected from a prospective database. Eligibility for transplantation was also studied. A lower weight loss (20 kg (16-30)) was observed in patients with ESRD within the first year as compared to matched patients (28 kg (21-34)) (P < 0.05). After a median follow-up of 30 (19-50) months in the ESRD group, contraindication due to morbid obesity was lifted in 20 patients. Twelve patients underwent transplantation. In patients with ESRD potentially eligible for transplantation, LSG allows similar weight loss in comparison with matched patients with normal renal function, enabling lifting contraindication for transplantation due to morbid obesity in the majority of patients within the first postoperative year.
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Affiliation(s)
- Martin Gaillard
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, Clamart, France.,Paris-Saclay University, Orsay, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, Clamart, France.,Paris-Saclay University, Orsay, France
| | - Séverine Beaudreuil
- Paris-Saclay University, Orsay, France.,Department of Nephrology, Kremlin Bicêtre Hospital, AP-HP, Le Kremlin Bicêtre, France
| | - Amandine Lebrun
- Paris-Saclay University, Orsay, France.,Department of Hepato-Gastroenterology and Nutrition, Antoine Béclère Hospital, AP-HP, Clamart, France
| | - Cosmin Sebastian Voican
- Paris-Saclay University, Orsay, France.,Department of Hepato-Gastroenterology and Nutrition, Antoine Béclère Hospital, AP-HP, Clamart, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, Clamart, France.,Paris-Saclay University, Orsay, France
| | - Rodi Courie
- Paris-Saclay University, Orsay, France.,Department of Hepato-Gastroenterology and Nutrition, Antoine Béclère Hospital, AP-HP, Clamart, France
| | - Gabriel Perlemuter
- Paris-Saclay University, Orsay, France.,Department of Hepato-Gastroenterology and Nutrition, Antoine Béclère Hospital, AP-HP, Clamart, France
| | - Bastien Parier
- Paris-Saclay University, Orsay, France.,Department of Urology, Kremlin Bicêtre Hospital, AP-HP, Le Kremlin Bicêtre, France
| | - Yacine Hammoudi
- Paris-Saclay University, Orsay, France.,Department of Urology, Kremlin Bicêtre Hospital, AP-HP, Le Kremlin Bicêtre, France
| | - Antoine Durrbach
- Paris-Saclay University, Orsay, France.,Department of Nephrology, Kremlin Bicêtre Hospital, AP-HP, Le Kremlin Bicêtre, France.,INSERM UMRS-MD1197, Villejuif, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, Clamart, France
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14
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Lainas P, Derienne J, Dammaro C, Schoucair N, Devaquet N, Dagher I. Single-port Laparoscopic Surgery for the Treatment of Severe Obesity: Review and Perspectives. Obes Surg 2020; 30:2781-2790. [DOI: 10.1007/s11695-020-04620-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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15
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Sun SD, Wu PP, Zhou JF, Wang ZS, Cai TH, Huang LK, Chen JS, Lin CQ, Wang JX, He QL. Comparison of Single-Incision and Conventional Laparoscopic Sleeve Gastrectomy for Morbid Obesity: a Meta-Analysis. Obes Surg 2020; 30:2186-2198. [PMID: 32060852 DOI: 10.1007/s11695-020-04437-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Single-incision laparoscopic sleeve gastrectomy (SILSG) has been proposed as an alternative to conventional laparoscopic sleeve gastrectomy (CLSG) in obese patients. This study aims to compare the surgical outcomes of these two techniques. METHODS A meta-analysis of existing literature obtained through a systematic literature search in the PubMed, EMBASE, and Cochrane Library CENTRAL databases from 2009 to 2019 was conducted. RESULTS Eleven articles including 1168 patients were analyzed. Patients in the SILSG group reported greater satisfaction with cosmetic scar outcomes than those in the CLSG group (SMD = 2.47, 95% CI = 1.10 to 3.83, P = 0.00). There was no significant difference between the SILSG group and the CLSG group regarding operative time, intraoperative estimated blood loss, conversion rate, intraoperative complications, length of hospital stay, postoperative analgesia, postoperative complications, excess weight loss (EWL), and improvements in comorbidities (P > 0.05). CONCLUSIONS Compared to CLSG, SILSG resulted in improved cosmetic satisfaction and showed no disadvantages in terms of surgical outcomes; thus, SILSG can serve as an alternative to CLSG for obese patients. Nonetheless, high-quality randomized controlled trials (RCTs) with large study populations and long follow-up periods are needed.
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Affiliation(s)
- Si-Da Sun
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Ping-Ping Wu
- Department of General Medicine, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Jun-Feng Zhou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Zhi-Sheng Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Tian-Hong Cai
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Long-Kai Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Jian-Sheng Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Chang-Qing Lin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Jia-Xing Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China
| | - Qing-Liang He
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.
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16
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Chelala E, El Hajj Moussa W, Rizk S, Assaker N. Consecutive Versus Selective Primary and Revisional Single Incision Laparoscopic Bariatric Surgery: Personal Experience in 330 Cases. Obes Surg 2019; 30:1515-1526. [PMID: 31858397 DOI: 10.1007/s11695-019-04356-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND This paper aims to retrospectively evaluate the feasibility, safety, and standardization for both consecutive primary and revisional SILS bariatric surgeries, and to analyze incisional hernia's prevalence, technical improvements, and limiting factors. METHODS A retrospective database review was undertaken involving, in Part I (Belgium), 290 consecutive SILS, including 80.68% primary bariatric surgeries, and 19.32% revisional gastric bypass, followed in Part II (Lebanon), by 40 selective primary SILS. Training for and standardization of the trans-umbilical technique was done for the operating room team, and was executed in part II. RESULTS The procedure of single incision was successfully completed in all of the 330 cases part I & part II. There was a need for additional salvage for one or two trocars in respectively 3.1% and 2.75% of the cases. There were no deaths or conversions in either group. Early complications included one medically healed fistula after revisional GB, and two secondary gastric and intestinal perforation requiring reoperations. Late surgical complications were: "3 patients (1.03%) in Part I and 2 (5%) in Part II suffered occlusions, requiring laparoscopic mesenteric defect's closure on an internal herniation." Twelve patients (4.1%) from part I and 5 (12.5%) in part II suffered an incisional hernia. CONCLUSION Selective SILS, when standardized, tends to be superior to consecutive SILS in terms of overall morbidity, operative time, and need for additional salvage trocars. Cost effectiveness and higher midterm rate of umbilical port site incisional hernia should be weighed against the beneficial cosmetic effect for the patient.
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Affiliation(s)
- Elie Chelala
- General Surgery Department, University Hospital Notre Dame des Secours, Byblos, Lebanon. .,Faculty of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon. .,General Surgery Department, University Hospital of Tivoli, La Louvière, Belgium.
| | - Wissam El Hajj Moussa
- General Surgery Department, University Hospital Notre Dame des Secours, Byblos, Lebanon.,Faculty of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Simon Rizk
- General Surgery Department, University Hospital Notre Dame des Secours, Byblos, Lebanon.,Faculty of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Nidal Assaker
- General Surgery Department, University Hospital Notre Dame des Secours, Byblos, Lebanon.,Faculty of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
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17
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Mauriello C, Chouillard E, d'alessandro A, Marte G, Papadimitriou A, Chahine E, Kassir R. Retrospective Comparison of Single-Port Sleeve Gastrectomy Versus Three-Port Laparoscopic Sleeve Gastrectomy: a Propensity Score Adjustment Analysis. Obes Surg 2019; 28:2105-2112. [PMID: 29663249 DOI: 10.1007/s11695-018-3244-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Evaluate the efficacy of single-port sleeve gastrectomy (SPSG) and then compare it to a less-invasive sleeve approach (three-port) (3PSG) according to a propensity score (PS) matching analysis. MATERIALS AND METHODS We analyzed all patients who underwent SG through a three-port or a single-port laparoscopic approach. RESULTS After 2 years, the follow-up was completed in 84% patients treated with 3PSG and 95% patients of the SPSG group. Excess weight loss (EWL) was comparable for the first year of follow-up within the two groups except for the controls at 3 months in which the SPSG group showed a higher EWL (p = 0.0243). CONCLUSION We demonstrated the efficacy of SPSG in bariatric surgery even compared to another, less invasive, laparoscopic SG approach (three-port).
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Affiliation(s)
- Claudio Mauriello
- Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France
| | - Elie Chouillard
- Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France
| | - Antonio d'alessandro
- Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France
| | - Gianpaolo Marte
- Department of Surgery, Regional Center for HPB Surgery, Regional Hospital of Treviso, 31100, Treviso, Italy
| | - Argyri Papadimitriou
- Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France
| | - Elias Chahine
- Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Félix Guyon, La réunion, Saint Denis, France. .,Department of Bariatric Surgery, CHU Felix-Guyon, La réunion, Saint Denis, France.
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18
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Tranchart H, Rebibo L, Gaillard M, Dhahri A, Lainas P, Regimbeau JM, Dagher I. Short-term outcomes of single-port versus conventional laparoscopic sleeve gastrectomy: a propensity score matched analysis. Surg Endosc 2019; 34:3978-3985. [PMID: 31595402 DOI: 10.1007/s00464-019-07175-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 09/26/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) has become a frequent bariatric procedure. Single-port sleeve gastrectomy (SPSG) could reduce parietal aggression however its development has been restrained due to fear of a complex procedure leading to increased morbidity and suboptimal sleeve construction. The aim of this study was to compare the short-term outcomes of SPSG versus conventional laparoscopic sleeve gastrectomy (CLSG) with regards to morbidity, weight loss, and co-morbidity resolution. METHODS Between January 2015 and December 2016, data from all consecutive patients that underwent SPSG and CLSG in two institutions performing exclusively one or the other approach were retrospectively analyzed. Propensity score adjustment was performed on the factors known to influence the choice of approach. RESULTS During the study period, 1122 patients underwent SG in both institutions (610 SPSG and 512 CLSG). From each group, 314 patients were successfully matched. A 15-min increase in operative time was observed during SPSG (P < 0.001). Postoperative morbidity was similar with a minor increase after SPSG (8.6 vs. 6.7%, P = 0.453). No differences in incisional hernia rates were observed (1.6 (SPSG) vs. 0.3% (CLSG), P = 0.216). Percentage of total weight loss was 31.1% and 28.2% in the CLSG and SPSG 12 months after surgery, respectively (P = 0.321). Co-morbidities resolution 12 months following the procedure was similar. CONCLUSIONS SPSG can be performed safely with similar intraoperative and postoperative morbidity compared to CLSG. Weight loss and co-morbidities resolution at 1 year are equivalent. A 15-min longer operative time was the only negative side of SPSG.
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Affiliation(s)
- Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, 92140, Clamart, France.
- Paris-Saclay University, 91405, Orsay, France.
| | - Lionel Rebibo
- Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, 80054, Amiens, France
- Research Unit BQR SSPC « Simplification of Surgical Patient Care », Jules Verne University of Picardie, 80054, Amiens, France
| | - Martin Gaillard
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, 92140, Clamart, France
- Paris-Saclay University, 91405, Orsay, France
| | - Abdennaceur Dhahri
- Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, 80054, Amiens, France
- Research Unit BQR SSPC « Simplification of Surgical Patient Care », Jules Verne University of Picardie, 80054, Amiens, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, 92140, Clamart, France
- Paris-Saclay University, 91405, Orsay, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, 80054, Amiens, France
- Research Unit BQR SSPC « Simplification of Surgical Patient Care », Jules Verne University of Picardie, 80054, Amiens, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, 92140, Clamart, France
- Paris-Saclay University, 91405, Orsay, France
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19
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Cawich SO, FaSiOen P, Singh Y, Francis W, Mohanty SK, Naraynsingh V, Dapri G. Single incision laparoscopic surgery from a caribbean perspective. Int J Surg 2019; 72S:13-18. [PMID: 31132463 DOI: 10.1016/j.ijsu.2019.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/16/2019] [Indexed: 12/20/2022]
Abstract
Conventional laparoscopy with multiple ports has recently gained a strong foothold in the Caribbean, but single incision laparoscopic surgery (SILS) has lagged behind. In this paper, we compare the data on SILS and conventional multi-port laparoscopy in the English-speaking Caribbean.
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Affiliation(s)
- Shamir O Cawich
- Department of Surgery, University of the West Indies, St. Augustine, West Indies, Trinidad and Tobago.
| | - Patrick FaSiOen
- Department of Surgery, St Elizabeth Hospital, Dutch Caribbean, Curacao
| | - Yardesh Singh
- Department of Surgery, University of the West Indies, St. Augustine, West Indies, Trinidad and Tobago
| | - Wesley Francis
- Department of Surgery, Princess Margaret Hosptial, Nassau, Bahamas
| | - Sanjib K Mohanty
- Department of Surgery, Cayman Islands Hospital, West Indies, Cayman Islands
| | - Vijay Naraynsingh
- Department of Surgery, University of the West Indies, St. Augustine, West Indies, Trinidad and Tobago
| | - Giovanni Dapri
- Department of Surgery, Saint Pierre University Hospital, Brussels, Belgium
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20
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Kırkıl C, Aygen E, Aktimur R, Korkmaz MF, Rzayev E. Laparoscopic Three-Port Sleeve Gastrectomy. Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2018.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cüneyt Kırkıl
- Department of General Surgery, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Erhan Aygen
- Department of General Surgery, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Recep Aktimur
- Department of General Surgery, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
| | - Mehmet Fatih Korkmaz
- Department of General Surgery, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Elshad Rzayev
- Department of General Surgery, Faculty of Medicine, Firat University, Elazig, Turkey
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21
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Lainas P, Dammaro C, Gaillard M, Donatelli G, Tranchart H, Dagher I. Safety and short-term outcomes of laparoscopic sleeve gastrectomy for patients over 65 years old with severe obesity. Surg Obes Relat Dis 2018; 14:952-959. [DOI: 10.1016/j.soard.2018.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/09/2018] [Accepted: 03/01/2018] [Indexed: 01/23/2023]
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22
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Magouliotis DE, Tasiopoulou VS, Svokos AA, Svokos KA, Sioka E, Zacharoulis D. Single Incision Versus Conventional Laparoscopic Sleeve Gastrectomy for Morbid Obesity: A Meta-Analysis. J Laparoendosc Adv Surg Tech A 2018; 28:690-699. [DOI: 10.1089/lap.2017.0245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
| | - Vasiliki S. Tasiopoulou
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Viopolis, Larissa, Greece
| | | | | | - Eleni Sioka
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
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23
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Abstract
BACKGROUND/INTRODUCTION Several reports have discussed the potential for reducing port access in laparoscopic sleeve gastrectomy (LSG); however, each approach had its innate setbacks. Aiming at improving the aesthetic outcome, we report a novel approach to the LSG where we place the trocars at the bikini line in what we described as bikini line sleeve gastrectomy (BLSG). METHODS The present work is a prospective, pilot study on the use of BLSG in patients, during the period between April and October 2016. Exclusion criteria included the following: large hiatal hernia, upper abdominal surgery, and xiphi-umbilical, xiphi-symphysis pubis, and xiphi-anterior superior iliac spine distances of > 25,36 and 33 cm, respectively. Four trocars were used: one at the umbilicus and three at the bikini line. All laparoscopic graspers were bariatric length instruments (43 cm). However, camera telescope, endoscopic stapler, and bipolar dissectors were standard length. RESULTS Twenty eight patients underwent BLSG. The mean age was 34.6 ± 3.7 years with a mean BMI of 42.46 kg/m2 ± 3. There were no major intra- or postoperative complications and no conversion to conventional port site placement. Patient's scar satisfaction was favorable. The mean postoperative BMI and weight at 6 m were 28.5 ± 1 kg/m2 and 79.8 kg ± 2, respectively. The mean percentage excess weight loss at 3, 6, and 12 months were 39.5 ± 4.6, 64.5 ± 5, and 69.8 ± 6%, respectively. CONCLUSION BLSG was found to be potentially safe, feasible, and effective with a favorable aesthetic outcome; it could possibly be offered to a select group of patients that are conscious about their scar appearance.
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Affiliation(s)
- Tamer N Abdelbaki
- General Surgery Department, Alexandria University Faculty of Medicine, 11 Hussein Nouh St, Shalalat, Bab Sharki, Alexandria, Egypt.
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24
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Kang SH, Park YS, Ahn SH, Park DJ, Kim HH. Laparoendoscopic Single-Site Bariatric Surgery: A Review of Single-Port Laparoscopic and Endoscopic Bariatric Treatments. J Obes Metab Syndr 2018; 27:25-34. [PMID: 31089537 PMCID: PMC6489492 DOI: 10.7570/jomes.2018.27.1.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 02/12/2018] [Accepted: 02/23/2018] [Indexed: 11/25/2022] Open
Abstract
Bariatric surgery is an established and effective treatment, not only to combat morbid obesity, but also to address associated metabolic comorbidities. At this time, the cutoff for bariatric or metabolic surgery in terms of body mass index (BMI) is decreasing, making it more feasible for certain individuals to consider minimally invasive surgical options. Innovations in the technique have led to the application of laparoendoscopic single-site surgery (LESS) in the field of bariatrics, which uses a single or no incision in the performance of weight-reducing surgery. To date, there is no consensus regarding patient selection though most candidates for single-port bariatric surgery are female. Some doctors suggest that single-port bariatric surgery may not be recommended in patients with BMI of more than 50 kg/m2, height of more than 180 cm, and xiphoid–umbilicus distance of more than 20 cm. Sleeve gastrectomy (SG) is now the most widely performed bariatric surgery worldwide and single-port SG (SPSG) is already established as a routine procedure in various institutions. Current evidence shows that SPSG is less painful and demonstrates higher rates of patient satisfaction regarding the wound. SPSG is feasible and is recommendable in patients who meet certain criteria. Furthermore, endoscopic treatment modalities such as intragastric balloons and endoluminal malabsorptive devices are being developed to bridge the gap between medical and surgical treatments. Nevertheless, there is still insufficient evidence to prove the superiority of LESS bariatric surgery over conventional laparoscopic surgery. Large, well-designed prospective analyses are needed to determine the criteria for selecting patients suitable to undergo LESS bariatric surgery and to predict the procedure’s role in the growth of bariatric surgery.
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Affiliation(s)
- So Hyun Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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25
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Preoperative Detection of Sarcopenic Obesity Helps to Predict the Occurrence of Gastric Leak After Sleeve Gastrectomy. Obes Surg 2018; 28:2379-2385. [DOI: 10.1007/s11695-018-3169-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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26
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Safety and Feasibility of Single-Port Sleeve Gastrectomy Following Liver Transplantation. Obes Surg 2017; 28:874-876. [DOI: 10.1007/s11695-017-3080-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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27
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Neagoe RM, Mureșan M, Bancu Ș, Balmos I, Băișan V, Voidăzan S, Sala D. Results of Laparoscopic Sleeve Gastrectomy-5-Year Follow-Up Study in an Eastern European Emerging Bariatric Center. Obes Surg 2017; 27:983-989. [PMID: 27738967 DOI: 10.1007/s11695-016-2407-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) has gained ground in Eastern Europe in the decade but fewer reports of large series with medium-term follow-up exist. We describe a single-surgeon experience in LSG (the first 101 consecutive cases) in a Balkan emerging bariatric center. METHODS A prospectively maintained database of the initial 101 consecutive patients submitted to LSG in our clinic between October 2010 and February 2016 was reviewed. RESULTS The percentages of mean excess weight loss (%EWL) in the 101 patients (mean age of 42 ± 10.6 years, 77 % female, median preoperative body mass index (BMI) of 44.5 kg/m2) were 51.3 (n = 82 followed-up patients) at 6 months postoperatively, 78.2 (n = 69) at 1 year, and 75.8 (n = 39), 77.1 (n = 20), 67.5 (n = 17), and 52.9 (n = 7) at 2, 3, 4, and 5 years, respectively. One year after LSG, all comorbidities showed remission or significant improvement in all 69 followed-up patients; the highest resolution was seen with hypertension (73.3 %). We noted a negative correlation between a decrease in %EWL and both the age of the patient and the initial state weight and BMI. The mortality in our group was nil; we had three cases (2.9 %) of bleeding and no leaks. CONCLUSIONS LSG is a safe procedure, with low postoperative morbidity rates and excellent short-term %EWL results up to 3 years after surgery, including resolution or improvement of the main obesity-related comorbidities. The results were superior in the category of younger and lower initial BMI obese patients.
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Affiliation(s)
- Radu Mircea Neagoe
- Surgery Clinic No. 2, University of Medicine and Pharmacy of Târgu Mureș, Gh. Marinescu St., No. 50, 540109, Tîrgu Mureș, Romania
| | - Mircea Mureșan
- Surgery Clinic No. 2, University of Medicine and Pharmacy of Târgu Mureș, Gh. Marinescu St., No. 50, 540109, Tîrgu Mureș, Romania.
| | - Șerban Bancu
- Surgery Clinic No. 2, University of Medicine and Pharmacy of Târgu Mureș, Gh. Marinescu St., No. 50, 540109, Tîrgu Mureș, Romania
| | - Ionuț Balmos
- Surgery Clinic No. 2, University of Medicine and Pharmacy of Târgu Mureș, Gh. Marinescu St., No. 50, 540109, Tîrgu Mureș, Romania
| | - Vasile Băișan
- Surgery Clinic No. 2, University of Medicine and Pharmacy of Târgu Mureș, Gh. Marinescu St., No. 50, 540109, Tîrgu Mureș, Romania
| | - Septimiu Voidăzan
- Epidemiology Department, University of Medicine and Pharmacy of Târgu Mureș, Tîrgu Mureș, Romania
| | - Daniela Sala
- Surgery Clinic No. 2, University of Medicine and Pharmacy of Târgu Mureș, Gh. Marinescu St., No. 50, 540109, Tîrgu Mureș, Romania
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28
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Dimitrokallis N, Alexandrou A, Schizas D, Angelou A, Pikoulis E, Liakakos T. Single-Incision Laparoscopic Sleeve Gastrectomy: Review and a Critical Appraisal. J Laparoendosc Adv Surg Tech A 2017; 27:217-226. [PMID: 28146416 DOI: 10.1089/lap.2016.0591] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Single-incision laparoscopic surgery has attracted a great deal of interest in the surgical community in recent years, including bariatric surgery. Single-incision laparoscopic sleeve gastrectomy (SILSG) has been proposed as an alternative to the multiport laparoscopic procedure; however, it has yet to meet wide acceptance and application. OBJECTIVE We aim to summarize existing data on SILSG and check the procedure's feasibility, technical details, safety, and, if possible, outcomes. MATERIALS AND METHODS We checked the most important databases for studies concerning SILSG and included all these that summarized the criteria placed and contained the data needed for this review. We excluded case reports. RESULTS Nineteen studies complied with the criteria of our review, containing a total of 1679 patients. Their mean age has been 38.91 years and the mean preoperative body mass index has been 41.8 kg/m2. In majority of cases (60.5%), a left upper quadrant incision has been preferred and in 97.6%, a commercially available multiport system has been picked. A wide variety of instruments have been used and mean operating time has been 94.6 minutes. One conversion to open surgery has been reported and 7.4% required the placement of additional ports. There was a complication rate of 7.38% (most common being bleeding with a rate of 2.5%) and a reoperation rate of 2.8%. Mean excess weight loss for a follow-up of 1 year was achieved in 53.7% of patients and was 70.06%. A tendency for less analgesia and better wound satisfaction has been reported. CONCLUSIONS SILSG is safe and feasible. However, there is insufficient evidence to recommend it as the new gold standard for sleeve gastrectomy in the place of conventional laparoscopic sleeve gastrectomy. Randomized controlled trials are needed to analyze the results and the possible benefits of this technique.
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Affiliation(s)
- Nikolaos Dimitrokallis
- 1st Department of Surgery, National Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Andreas Alexandrou
- 1st Department of Surgery, National Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, National Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Anastasios Angelou
- 1st Department of Surgery, National Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Emmanouil Pikoulis
- 1st Department of Surgery, National Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Theodoros Liakakos
- 1st Department of Surgery, National Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Kozlowski T, Kozakiewicz K, Dadan J, Mysliwiec P. Innovative solutions in bariatric surgery. Gland Surg 2016; 5:529-536. [PMID: 27867868 DOI: 10.21037/gs.2016.10.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Nowadays all over the world the rising plague of obesity can be observed. The obesity was recognized as "an epidemic of XXI century" in 1997 by World Health Organization. The change of eating habits, active lifestyle or pharmacological curation are often insufficient to fight against obesity. Nowadays, there are not any guidelines about gold standard for curing obese patients is bariatric surgery. At the moment, two types of bariatric procedures: laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy, are most commonly used. There are also some other new approaches, which are still being investigated. The mechanism of losing weight in bariatric surgery is based on restriction, malabsorption and neurohormonal effect. Not only is the surgery technique very important to succeed, but also the postoperative care in the outpatient clinic. This article reviews the new possibilities in obesity treatment.
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Affiliation(s)
- Tomasz Kozlowski
- 1 Department of General and Endocrinological Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Krzysztof Kozakiewicz
- 1 Department of General and Endocrinological Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Jacek Dadan
- 1 Department of General and Endocrinological Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Piotr Mysliwiec
- 1 Department of General and Endocrinological Surgery, Medical University of Bialystok, Bialystok, Poland
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