Skip to main content
Erschienen in: Obesity Surgery 3/2015

01.03.2015 | Original Contributions

Transumbilical Single-Incision Laparoscopic Sleeve Gastrectomy

verfasst von: José Ignacio Fernández Fernández, Carlos O. Farías, Cristián L. Ovalle, Carolina S. Cabrera, Jaime C. de la Maza

Erschienen in: Obesity Surgery | Ausgabe 3/2015

Einloggen, um Zugang zu erhalten

Abstract

Background

Sleeve gastrectomy has become an established primary bariatric surgical technique. Its relatively lower complexity has made it eligible to be performed by single-incision laparoscopy (single-incision laparoscopic sleeve gastrectomy, SILSG). The aim of this paper is to present our SILSG technique and surgical outcomes and demonstrate that SILSG is a safe and feasible procedure using conventional laparoscopic instruments.

Methods

All patients who underwent SILSG since December 2012 in our institution were analyzed. The operative technique involved creation of a transumbilical incision and the introduction of a GelPoint device with four trocars. Rigid instruments were used in all patients. Gastric transection was performed 4 cm proximal to the pylorus and calibrated with a 36-Fr bougie. Hemostasis of the staple line was achieved with metallic clips.

Results

A total of 74 patients underwent SILSG. Their mean age and body mass index were 34.2 ± 9.2 years and 34.0 ± 3.2 kg/m2 (range 30.0–42.7 kg/m2), respectively. The mean operative time was 48 ± 10 min. No reoperations or deaths occurred. One patient developed portal vein thrombosis. The mean length of hospital stay was 2.4 ± 2.0 days. The cosmetic result was satisfactory in all patients.

Conclusions

SILSG is a safe and feasible procedure when performed with the technique described herein. This technique allows for the use of conventional laparoscopic instruments and reasonable operative times. The main benefit of the procedure is an excellent cosmetic result with virtually no visible scars.
Literatur
1.
Zurück zum Zitat Gumbs AA, Gagner M, Dakin G, et al. Sleeve gastrectomy for morbid obesity. Obes Surg. 2007;17:962–9.CrossRefPubMed Gumbs AA, Gagner M, Dakin G, et al. Sleeve gastrectomy for morbid obesity. Obes Surg. 2007;17:962–9.CrossRefPubMed
2.
Zurück zum Zitat Gagner M, Deitel M, Erickson AL, et al. Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy. Obes Surg. 2013;23:2013–7.CrossRefPubMed Gagner M, Deitel M, Erickson AL, et al. Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy. Obes Surg. 2013;23:2013–7.CrossRefPubMed
3.
Zurück zum Zitat Saber AA, Elgamal MH, Itawi EA, et al. Single incision laparoscopic sleeve gastrectomy (SILS): a novel technique. Obes Surg. 2008;18:1338–42.CrossRefPubMed Saber AA, Elgamal MH, Itawi EA, et al. Single incision laparoscopic sleeve gastrectomy (SILS): a novel technique. Obes Surg. 2008;18:1338–42.CrossRefPubMed
4.
Zurück zum Zitat Reavis KM, Hinojosa MW, Smith BR, et al. Single-laparoscopic incision transabdominal surgery sleeve gastrectomy. Obes Surg. 2008;18:1492–4.CrossRefPubMed Reavis KM, Hinojosa MW, Smith BR, et al. Single-laparoscopic incision transabdominal surgery sleeve gastrectomy. Obes Surg. 2008;18:1492–4.CrossRefPubMed
5.
Zurück zum Zitat Nguyen NT, Reavis KM, Hinojosa MW, et al. Laparoscopic transumbilical sleeve gastrectomy without visible abdominal scars. Surg Obes Relat Dis. 2009;5:275–7.CrossRefPubMed Nguyen NT, Reavis KM, Hinojosa MW, et al. Laparoscopic transumbilical sleeve gastrectomy without visible abdominal scars. Surg Obes Relat Dis. 2009;5:275–7.CrossRefPubMed
6.
Zurück zum Zitat Saber AA, El-Ghazaly TH, Elian A. Single-incision transumbilical laparoscopic sleeve gastrectomy. J Laparoendosc Surg. 2009;19:755–8. discussion 759.CrossRef Saber AA, El-Ghazaly TH, Elian A. Single-incision transumbilical laparoscopic sleeve gastrectomy. J Laparoendosc Surg. 2009;19:755–8. discussion 759.CrossRef
7.
Zurück zum Zitat Varela JE. Single-site laparoscopic sleeve gastrectomy: preclinical Use of a novel multi-access port device. Surg Innov. 2009;16:207–10.CrossRefPubMed Varela JE. Single-site laparoscopic sleeve gastrectomy: preclinical Use of a novel multi-access port device. Surg Innov. 2009;16:207–10.CrossRefPubMed
8.
Zurück zum Zitat Arias Amezquita F, Prada Ascencio NE, Gomez D, et al. Transumbilical sleeve gastrectomy. Obes Surg. 2010;20:232–5.CrossRefPubMed Arias Amezquita F, Prada Ascencio NE, Gomez D, et al. Transumbilical sleeve gastrectomy. Obes Surg. 2010;20:232–5.CrossRefPubMed
9.
Zurück zum Zitat Gentileschi P, Camperchioli I, Benavoli D, Lorenzo ND, Sica G, Gaspari AL (2010) Laparoscopic single-port sleeve gastrectomy for morbid obesity: preliminary series. Surg Obes Relat Dis Gentileschi P, Camperchioli I, Benavoli D, Lorenzo ND, Sica G, Gaspari AL (2010) Laparoscopic single-port sleeve gastrectomy for morbid obesity: preliminary series. Surg Obes Relat Dis
10.
Zurück zum Zitat Farias C, Fernandez JI, Ovalle C, et al. Transumbilical sleeve gastrectomy with an accessory lateral port: surgical results in 237 patients and 1-year follow-up. Obes Surg. 2013;23:325–31.CrossRefPubMed Farias C, Fernandez JI, Ovalle C, et al. Transumbilical sleeve gastrectomy with an accessory lateral port: surgical results in 237 patients and 1-year follow-up. Obes Surg. 2013;23:325–31.CrossRefPubMed
11.
Zurück zum Zitat Carrasco F, Klaassen J, Papapietro K, et al. A proposal of guidelines for surgical management of obesity. Rev Med Chil. 2005;133:699–706.PubMed Carrasco F, Klaassen J, Papapietro K, et al. A proposal of guidelines for surgical management of obesity. Rev Med Chil. 2005;133:699–706.PubMed
12.
Zurück zum Zitat Kala Z, Hanke I, Neumann C. A modified technic in laparoscopy-assisted appendectomy—a transumbilical approach through a single port. Rozhl Chir. 1996;75:15–8.PubMed Kala Z, Hanke I, Neumann C. A modified technic in laparoscopy-assisted appendectomy—a transumbilical approach through a single port. Rozhl Chir. 1996;75:15–8.PubMed
13.
Zurück zum Zitat Navarra G, Pozza E, Occhionorelli S, et al. One-wound laparoscopic cholecystectomy. Br J Surg. 1997;84:695.CrossRefPubMed Navarra G, Pozza E, Occhionorelli S, et al. One-wound laparoscopic cholecystectomy. Br J Surg. 1997;84:695.CrossRefPubMed
14.
Zurück zum Zitat Pearl JP, Ponsky JL. Natural orifice translumenal endoscopic surgery: a critical review. J Gastrointest Surg. 2008;12:1293–300.CrossRefPubMed Pearl JP, Ponsky JL. Natural orifice translumenal endoscopic surgery: a critical review. J Gastrointest Surg. 2008;12:1293–300.CrossRefPubMed
15.
Zurück zum Zitat Hall TC, Dennison AR, Bilku DK, et al. Single-incision laparoscopic cholecystectomy: a systematic review. Arch Surg. 2012;147:657–66.CrossRefPubMed Hall TC, Dennison AR, Bilku DK, et al. Single-incision laparoscopic cholecystectomy: a systematic review. Arch Surg. 2012;147:657–66.CrossRefPubMed
16.
Zurück zum Zitat Ohno Y, Morimura T, Hayashi SI. Transumbilical laparoscopically assisted appendectomy in children: the results of a single-port, single-channel procedure. Surg: Endosc; 2011. Ohno Y, Morimura T, Hayashi SI. Transumbilical laparoscopically assisted appendectomy in children: the results of a single-port, single-channel procedure. Surg: Endosc; 2011.
17.
Zurück zum Zitat Saber AA, El-Ghazaly TH. Single-incision transumbilical laparoscopic right hemicolectomy using SILS port. Am Surg. 2011;77:252–3.PubMed Saber AA, El-Ghazaly TH. Single-incision transumbilical laparoscopic right hemicolectomy using SILS port. Am Surg. 2011;77:252–3.PubMed
18.
Zurück zum Zitat Saber AA, El-Ghazaly TH. Feasibility of single-access laparoscopic sleeve gastrectomy in super-super obese patients. Surg Innov. 2010;17:36–40.CrossRefPubMed Saber AA, El-Ghazaly TH. Feasibility of single-access laparoscopic sleeve gastrectomy in super-super obese patients. Surg Innov. 2010;17:36–40.CrossRefPubMed
19.
20.
Zurück zum Zitat Pourcher G, Di Giuro G, Lafosse T, et al. Routine single-port sleeve gastrectomy: a study of 60 consecutive patients. Surg Obes Relat Dis. 2013;9:385–9.CrossRefPubMed Pourcher G, Di Giuro G, Lafosse T, et al. Routine single-port sleeve gastrectomy: a study of 60 consecutive patients. Surg Obes Relat Dis. 2013;9:385–9.CrossRefPubMed
21.
Zurück zum Zitat Pisanu A, Reccia I, Porceddu G, et al. Meta-analysis of prospective randomized studies comparing single-incision laparoscopic cholecystectomy (SILC) and conventional multiport laparoscopic cholecystectomy (CMLC). J Gastrointest Surg. 2012;16:1790–801.CrossRefPubMed Pisanu A, Reccia I, Porceddu G, et al. Meta-analysis of prospective randomized studies comparing single-incision laparoscopic cholecystectomy (SILC) and conventional multiport laparoscopic cholecystectomy (CMLC). J Gastrointest Surg. 2012;16:1790–801.CrossRefPubMed
22.
Zurück zum Zitat Song T, Liao B, Liu J, et al. Single-incision versus conventional laparoscopic cholecystectomy: a systematic review of available data. Surg Laparosc Endosc. 2012;22:e190–6.CrossRef Song T, Liao B, Liu J, et al. Single-incision versus conventional laparoscopic cholecystectomy: a systematic review of available data. Surg Laparosc Endosc. 2012;22:e190–6.CrossRef
23.
Zurück zum Zitat Saber AA, El-Ghazaly TH, Dewoolkar AV, et al. Single-incision laparoscopic sleeve gastrectomy versus conventional multiport laparoscopic sleeve gastrectomy: technical considerations and strategic modifications. Surg Obes Relat Dis. 2010;6:658–64.CrossRefPubMed Saber AA, El-Ghazaly TH, Dewoolkar AV, et al. Single-incision laparoscopic sleeve gastrectomy versus conventional multiport laparoscopic sleeve gastrectomy: technical considerations and strategic modifications. Surg Obes Relat Dis. 2010;6:658–64.CrossRefPubMed
24.
Zurück zum Zitat Dentali F, Romualdi E, Ageno W. The metabolic syndrome and the risk of thrombosis. Haematologica. 2007;92:297–9.CrossRefPubMed Dentali F, Romualdi E, Ageno W. The metabolic syndrome and the risk of thrombosis. Haematologica. 2007;92:297–9.CrossRefPubMed
25.
Zurück zum Zitat Dentali F, Squizzato A, Ageno W. The metabolic syndrome as a risk factor for venous and arterial thrombosis. Semin Thromb Hemost. 2009;35:451–7.CrossRefPubMed Dentali F, Squizzato A, Ageno W. The metabolic syndrome as a risk factor for venous and arterial thrombosis. Semin Thromb Hemost. 2009;35:451–7.CrossRefPubMed
26.
Zurück zum Zitat Ay C, Tengler T, Vormittag R, et al. Venous thromboembolism—a manifestation of the metabolic syndrome. Haematologica. 2007;92:374–80.CrossRefPubMed Ay C, Tengler T, Vormittag R, et al. Venous thromboembolism—a manifestation of the metabolic syndrome. Haematologica. 2007;92:374–80.CrossRefPubMed
Metadaten
Titel
Transumbilical Single-Incision Laparoscopic Sleeve Gastrectomy
verfasst von
José Ignacio Fernández Fernández
Carlos O. Farías
Cristián L. Ovalle
Carolina S. Cabrera
Jaime C. de la Maza
Publikationsdatum
01.03.2015
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 3/2015
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-014-1414-8

Weitere Artikel der Ausgabe 3/2015

Obesity Surgery 3/2015 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.