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

Annals of surgical innovation and research Pub Date : 2015-10-15 eCollection Date: 2015-01-01 DOI:10.1186/s13022-015-0016-z
Ivan Alberto Zepeda Mejia, Tomasz Rogula
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引用次数: 9

Abstract

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.

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腹腔镜单切口胃旁路术:初步经验、技术及近期疗效。
背景:单切口腹腔镜手术(SILS)的研究有限。本研究的目的是描述我们的技术,并评估SILS Roux-en-Y胃旁路术(RYGB)在单一中心选定的一组患者中的短期结果和疗效。方法:2012年3月至2013年1月,在美国俄亥俄州克利夫兰克利夫兰诊所的体重与代谢研究所,共有14例患者采用单切口2.5- 3cm脐内垂直切口,经膜放置3个孔,并采用肝悬浮技术进行了SILS RYGB手术。本研究回顾性分析了患者选择、短期结果和技术问题。结果:共14例病态肥胖患者(女12例,男2例;平均年龄46岁)。平均手术时间为196(131-265)分钟。手术时平均体重为113 (91-135)kg。1例患者需要放置一个额外的端口(7%)。不需要转换到传统腹腔镜手术(CLS)或开放手术。估计失血量为40(范围20-100)ml。在疼痛控制方面,患者自控镇痛的频率在术后第0天(POD)平均使用21次,POD1 37次,POD2 13次。疼痛评分(以视觉模拟量表评估)中位评分为POD0 6.9分,POD1 5.2分,POD2 3.8分。术后第一次就诊后体重减轻约7.25磅(±4.5),1个月后体重减轻28.9磅(±11.86),4个月后体重减轻45.4磅(±15.4)。术后90天内无患者需要再次手术或再入院。结论:在精心挑选的患者中,单切口是可行、安全、可重复性好的,可作为胃分流术等复杂手术的通道。短期结果与文献中观察到的结果相当。一些潜在的好处包括减少术后疼痛,改善美容,提高患者满意度。有必要进行随机试验,包括更大的患者系列、更长的随访时间和更大的队列研究和/或系统评价,以评估SILS在减肥手术中的利弊程度。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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