Single-Incision Sleeve Gastrectomy versus Laparoscopic Sleeve Gastrectomy: A case-control study

Elie K Chouillard, MD, PhD, Ronald Daher, MD, Georges Khoury, MD, Elias Chahine, MD, Nelson Trelles, MD. Division of Bariatric Surgery, Department of General Surgery, Poissy Saint Germain Medical Center.

Introduction: Miniaturization of the access into the abdominal cavity is, nowadays, gaining popularity. Theoretical advantages include reduced abdominal wall complications, less postoperative pain, reduced genesis of adhesions, shorter hospital stay, faster return to activity and productivity, and preserved cosmesis. Due to the still unresolved technical hurdles, the so-called “hybrid” NOTES approach and the Single Incision techniques were developed. Obese patients may theoretically benefit most from these techniques due to a would-be lower abdominal wall-related morbidity. We undertook a retrospective case-control study evaluating the Single Incision Sleeve Gastrectomy (SISG) as compared to the conventional laparoscopic Sleeve Gastrectomy (LSG).

Methods and Procedures: Between January 2008 and September 2011, our group performed 921 SG. Of these, 127 were performed using the Single Incision technique. Considering the first 20 SISG as serving to accomplish the learning curve, we decide to compare the next 107 patients who had SISG (Group A) to 107 patients who had LSG (Group B), matched for age, sex, and BMI.

The two groups were compared regarding operative parameters, post-operative pain management, rate of fistula, and mid-term outcome at 1 year follow-up

Results : 107 patients were considered eligible for the study in each group. The conversion rate (i.e., any additional port insertion or laparotomy) was 5.6 % in Group A and 0.9 % in Group B (p<0.05). No major operative incident was deplored. Mortality was 0 %. No patient was transfused. Operative duration was 110 minutes in Group A (60-280 minutes) and 79 minutes in Group B (44-181) (p<0.05). Oral diet was resumed on POD 1 (1-4) in Group A and on POD 3 (1-4) in Group B (p<0.05). The postoperative morbidity rate was 4.6% in Group A and 7.4 % in Group B (p>0.05). The amount of pain killers in Group A was rated 3.6 upon a local score we developed as compared to 7.8 in the Group B (p<0.05). One leak was observed was observed in Group A (0.9 %) and 2 leaks in Group B (1.9 %) (p>0.05). The median duration of hospital stay was 2 days (0-7) in Group A and 3 days (2-12) in Group B (p>0.05) . Mean follow-up was 16 months in Group A (11-56) and 19 months in Group B (12-66). Weight loss patterns were comparable in both groups (p>0.05). Two patients in each group had an incisional hernia.

Conclusions: SISG has longer operative duration as compared to LSG. However, SISG seems to be associated to lower post-operative pain and shorter hospital stay. Leak rate, short-term weight loss and 1-year incisional hernia rate are comparable.

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