Original article
Single-port sleeve gastrectomy for super-obese patients

https://doi.org/10.1016/j.soard.2015.12.001Get rights and content

Abstract

Background

Laparoscopic sleeve gastrectomy, which has become a primary bariatric procedure in super-obese patients (SOPs), is associated with considerable weight loss. Traditionally, laparoscopic sleeve gastrectomy requires 4–7 skin incisions. Single-port laparoscopic surgery is now feasible for bariatric surgery.

Objectives

To evaluate the feasibility and safety of single-port sleeve gastrectomy (SPSG) for SOPs.

Setting

Department of Abdominal and Minimally Invasive Surgery, Antoine Beclere Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Sud University, France.

Methods

Evaluation of the outcomes on patients who underwent surgery consecutively from June 2010 to June 2013 with follow-up of>1 year.

Results

In total, 62 patients (46 women, 16 men) underwent SPSG. The median age was 41 years (range 19–67), median preoperative body mass index was 52.2 kg/m2 (range 50–87), median operative time was 89 minutes (range 42–212). Twelve patients required additional trocars, and 4.8 % developed complications. The median postoperative stay was 4 days (range 3–9 days) and median follow-up period was 21 months (range 12–48 months) with no loss of follow-up. The median percentage of excess weight loss was 69.7% (range 52%–100%) and percentage of weight loss was 36% (28%–56%) for the same period.

Conclusion

SPSG for SOPs was found to be technically feasible, reproducible, and safe in this series.

Section snippets

Patients and methods

All SOPs (BMI>50 kg/m2) who underwent SPSG in our department from June 2010 to June 2013 were included in our study. The indications for bariatric surgery were in accordance with the French recommendations [16]. All patients underwent meticulous evaluation before surgery by a multidisciplinary team consisting of an endocrinologist, a gastroenterologist, a psychiatrist, a nutritionist, an anesthesiologist, and a surgeon. Appropriate preoperative investigations were performed, as indicated

Results

Sixty-two patients were included in our study (Table 2). Median age was 41 years (range 19–67 years) and 46 patients (74.1%) were women. Median weight was 140 kg (range 121–222 kg), with a median BMI of 52.2 kg/m2 (range 50–87 kg/m2).

Co-morbidities were as follows : T2D in 8 patients (12.9%), hypertension in 30 patients (48.3%), obstructive sleep apnea syndrome in 45 patients (72.5%), hyperlipidemia in 18 patients (29%), degenerative osteoarthritis in 35 patients (56.4%), back pain in 37

Discussion

LSG provides various advantages, such as shorter duration of surgery, absence of gastrointestinal anastomosis and postoperative internal hernias, and lower incidence of vitamin deficiencies or malabsorption [5], [19]. LSG is increasing in popularity, and in the medium-term follow-up, it is an effective weight loss procedure with an acceptable safety profile. LSG using 4 to 7 skin incisions has been proposed as a primary bariatric procedure, even in high-risk patients, such as SOPs. The natural

Conclusion

We have reported the largest series of SPSGs for SOPs in routine practice, showing the feasibility, safety, and efficacy of this technique in this specific population. We should not hesitate to add extra trocars should any technical difficulty arise. SPSG for SOP has to be performed in specialized centers, by bariatric surgeons well-experienced in both conventional laparoscopic surgery and single-incision surgery. Further prospective randomized studies have to performed to recommend SPSG for

Disclosure

The authors have no commercial associations that might be a conflict of interest in relation to this article.

References (28)

  • J. Taller et al.

    Single-incision laparoscopic sleeve gastrectomy for morbid obesity: video technique and review of first 10 patients

    Surg Obes Relat Dis

    (2010)
  • L. Sjostrom et al.

    Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications

    JAMA

    (2014)
  • L. Sjostrom et al.

    Effects of bariatric surgery on mortality in Swedish obese subjects

    N Engl J Med

    (2007)
  • H. Buchwald et al.

    Bariatric surgery: a systematic review and meta-analysis

    JAMA

    (2004)
  • View full text