Sils, Dils and Thrills: An evaluation of single incision surgery in laparoscopic gastric banding.
T Ayoung-Chee, H Hoang, F Colonna, C Magallanes, A Finger, G Rosario, H Youn, C Ren-Fielding, G Fielding, M Kurian
Objective: Decreasing the number of incisions in laparoscopic surgery is the newest trend, and one that is not universally accepted as yet. This technique has multiple monikers including SILS, SPA, LESS and SLIT, and is applied for multiple procedures including cholecystectomy, Nissen fundoplication, sleeve gastrectomy, colon resection and gastric banding. Purported benefits with single incision laparoscopic surgery (SILS) are cosmesis and perhaps a decrease in postoperative pain. We evaluate the introduction of SILS into our practice to define parameters that allow us to complete the procedure with a minimum of incisions.
Methods: A retrospective review of a prospective IRB approved database from December 2008 to present. Variables collected include sex, BMI, operative time, number of incisions, distance from xiphoid to umbilicus, prior surgery, additional procedures during banding and complications. All patients were considered for a periumbilical SILS approach, and patients that had a very long torso were excluded. All SILS procedures were performed with the aid of an articulating instrument.
Results: 321patients were identified after the introduction of SILS. The majority of the procedures (280/321) were DILS, or “double incision” with the liver retractor through a separate 5mm incision. 84/303 patients had a concomitant hiatal hernia repair. Average BMI, distance from umbilical to xiphoid incision and operative time were 43.2 kg/m2 (range 34.1-57.9), 21.6cm (range 10.5-27cm), and 46 (range 25-120 minutes) minutes. Average height was 66 inches. 10/321 patients required additional trocars. Addition of trocars was dictated by adhesions, distance from the umbilicus to the GE junction and intraabdominal fat. Complications include seroma (48/321), and wound infection with port removal (1/321).
Conclusions: The benefit of the periumbilical incision is cosmesis and in the case of the banding patient, privacy. Single incision technique can be applied safely in gastric banding with minimal morbidity. Placement of the liver retractor through a separate site allows more morbidly obese patients to have this approach. Variables that determine successful completion of the procedure include adhesions from prior surgery, intraabdominal fat obscuring visualization and distance from umbilicus to GE junction, which can be extrapolated from distance from umbilicus to xiphoid and patient height.
Program Number: P059