Single-incision laparoscopic surgery (SILS), a new trend in minimally invasive surgery, has the potential for decreased post-operative pain and port site complications as well as improved cosmesis. To date, only case reports and small series have been published regarding the technique and safety of this approach. We present a large series of SILS insertion of an adjustable gastric band through a single umbilical incision. The aim of our study was to evaluate demographics, efficacy, perioperative complications and short-term follow-up.
A retrospective review of a prospectively maintained database was evaluated for patients undergoing laparoscopic insertion of an adjustable gastric band at a single institution by a single surgeon. For all patients, multiple ports were placed through a single incision in the umbilicus. A standard pars flaccida technique was performed using standard laparoscopic instruments with the aid of a Genzyme liver retractor (Genzyme Corp., Cambridge, MA) and a RealHand Grasper (Novare Surgical Systems, Inc., Cupertino, CA). Patients were evaluated for age, sex, pre-operative body mass index (BMI), and perioperative complications, as well as post-operative weight loss. Results were compared to historical cohorts at the same institution and analyzed using SPSS 16.0.
From December 2007 to August 2009, a SILS approach was used to insert an adjustable gastric band in 100 patients. The average age was 40 ± 12 years (range: 20-67 years) and the patients were predominantly female (88%). Average pre-operative BMI was 42.7 ± 5.4 kg/m2 (range 29.7-56.3 kg/m2) including 4 patients with a BMI greater than 50 kg/m2. Five patients had coexisting hiatal hernias which were repaired primarily. There were no intra-operative complications. Post-operatively, two patients developed seromas and one patient developed a port site wound infection; all three were successfully managed non-operatively with oral antibiotics. A single port flipped precluding percutaneous access and required operative revision. These complication rates correspond to our institution’s experience with traditional laparoscopic gastric banding and did not reach statistical significance. Follow-up ranged from 1-18 months post-operatively, with mean weight loss 38.0 ± 17.7 pounds at 6 months post-operatively, corresponding to an average BMI of 35.8 ± 3.7 kg/m2 for a decrease of 16%.
The efficacy and safety of SILS insertion of an adjustable gastric band is comparable to traditional laparoscopic approaches. Complication rates are acceptable and short-term follow-up reveals comparable weight loss. Future studies will analyze risk factor stratification and long term follow-up.
Program Number: P050