Single Incision Laparoscopic Gastric Bypass Using Eea Technique

Sunil K Sharma, MD, Ziad T Awad, MD, Bestoon Ahmad, MD, T. Shane Hester. University of Florida, Jacksonville, FL

Introduction: Laparoscopic Roux en Y Gastric Bypass is one of the most commonly performed weight loss surgery in United States. This complex reconstructive surgery requires high level of expertise with little room for error. Single Incision Laparoscopic Surgery (SILS) is a new approach where by the whole surgery is performed using a small incision and inserting multiple ports thru it. Better cosmetics, less pain and faster recovery are potential advantages of this approach. Inadequate visualization, lack of space, expensive equipments, long operating time and being potentially unsafe are often criticism to the procedure. SILS has been successfully performed and reported for cholecystectomy, sleeve gastrectomy and lap band surgery. For the first time we are reporting our technique for performing Single Incision Laparoscopic Surgery for Roux en Y Gastric Bypass using EEA Stapler Technique.
Method: Steps of Operation: Gelpoint port is used thru a 4cm supra umbilical incision. 45 degree angle scope, regular bariatric instrument and reusable articulating instruments were used. Gastric pouch is created using articulating staplers. Orovil is passed by anesthesiologist using glidoscope and delivered out through posterior wall of pouch. Standard jejuno- jejunostomy is created after measuring the roux limb. Enterotomy is stapled keeping bowel in midline position. Roux limb is then delivered out through Gelpoint port. EEA 25mm stapler is introduced keeping wound protector. Spike is advanced under vision, aligned to anvil and fired to Create GJ anastomosis. Endoscopy is performed to check for leak or bleeding. Incision is closed in layers.

We performed retrospective analysis of first 19 patients who underwent SILS LGBP over a period of 4 months. Selection criteria included BMI 35 -60, no prior major upper abdominal surgery and patient consenting for the approach.
Result: Attempted in 18 patients. 6 patients required additional single 5mm port. Average operating time was 130 min with minimal blood loss. No major complication, no leak on EGD and upper GI. Average hospital stay 30 hours. 3 patients developed small seroma which required drainage but no hospitalization.
Conclusion: SILS LGBP is a reasonable option for selected patients. The procedure is safe and can be performed in a reasonable time with a potential of faster recovery, less pain, early discharge and better cosmetic outcome.