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Erschienen in:
15.08.2015
Weight-loss outcomes of SPIDER® sleeve gastrectomy at 6 months compared to traditional laparoscopic technique
Erschienen in: Surgical Endoscopy | Ausgabe 5/2016
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Background
Laparoscopic sleeve gastrectomy (LSG) has become a primary stand-alone procedure for weight-loss surgery. The standard technique for LSG involves several small abdominal incisions. The single port instrument delivery extended reach (SPIDER®) surgical system has been introduced as a single site modality. This technique has been described previously; however, weight-loss outcomes of SPIDER® sleeve gastrectomy have not been compared to multi-port LSG.
Methods
We performed a retrospective review of a prospectively collected database. All cases were performed by a single surgeon between August 2011 and September 2013. Thirty-two patients underwent SPIDER® sleeve gastrectomy, while 30 underwent LSG. Primary outcomes were change in BMI and percent excess weight loss (%EWL) at 6 months post-operatively. Secondary outcomes included: operative time, estimated blood loss (EBL), and complications.
Results
There were no demographic differences between cohorts except initial BMI (SPIDER® = 42.1, LSG = 46.5, p < 0.001). Mean %EWL at 6 months post-operatively was higher in the SPIDER® cohort (59.1 vs. 48.3 %, p < 0.005). Similarly there was a lower mean BMI at 6 months post-operatively in the SPIDER® cohort (31.1 vs. 35.5, p < 0.0001). The net change in BMI for each cohort was equivalent (SPIDER® = 11.1, LSG = 11.0, p = 0.95). Mean operative time was longer in SPIDER® cases (104.6 vs. 90.7 min, p < 0.02), while EBL was equivalent (32.1 vs. 34.3 mL, p = 0.56). There was one post-operative hemorrhage requiring laparoscopic clot evacuation in the SPIDER® cohort, and one wound infection in the LSG cohort.
Conclusions
SPIDER® sleeve gastrectomy is not inferior to LSG with regard to decrease in BMI and %EWL at 6-months post-operatively. The higher %EWL observed in the SPIDER® cohort is likely due to patient selection bias. This study demonstrates that the SPIDER® technique is a viable alternative to LSG with similar weight-loss outcomes.