Introduction: Techniques which limit incisions, such as NOTES (Natural Orifice
Translumenal Endoscopic Surgery) or single port surgery have gained much
attention recently. They are thought to have many benefits. Some
investigators have applied these techniques to bariatric surgery. We
have assessed the safety of Roux-en-y gastric bypass surgery using
microlaparoscopy techniques as an alternative.
Methods: Retrospective analysis of institutional NSQIP (National Surgery Quality
Improvement Program) data of two bariatric surgeons, one using
microlaparoscopy (group 1) the other using standard techniques (group2).
We define microlaparoscopy as gastric bypass performed using three 3 mm
trocars and one 12mm trocar. The standard procedure was performed using
two 12mm trocars and two 5mm trocars. The NSQIP data was analyzed for
demographics, risk factors and outcomes variables.
Results: The surgeons performed 170 and 220 cases over a 19 month period for
group 1 and 2 repsectively. There was no statistical difference in age,
male/female distribution, average BMI, ASA class and risk factors
between the two groups. All cases were completed without conversion. None of the
microlaparoscopic cases had to be upgraded in trocar size. There was no
statistical difference between the two methods in mortality (0% each),
return to OR within 30 days (1.8% vs. 0.9%) and postoperative
occurrences (4.7% vs. 2.3%).
Conclusion: We conclude that microlaparoscopic gastric bypass is as safe as
traditional laparoscopic gastric byass. Further randomized studies are
warranted to fully compare both methods both from a clinical and cost
point of view.
Program Number: P036