Single Incision Laparoscopic Surgery (sils) and Notes in Bariatrics

Elie K Chouillard, MD PhD, Nelson Trelles, MD, Andrew Gumbs, MD FACS. On behalf of the Intercontinental Society of Natural Orifice, Endoscopic, and Laparoscopic Surgery (INOELS)Centre Hospitalier Intercommunal, Poissy, France

Background: Natural Orifice Translumenal Endoscopic Surgery (NOTES) is an evolving concept. Many variants have been described including « pure » NOTES, « Hybrid » NOTES, single incision laparoscopic surgery (SILS), or even NOTES-inspired endoscopic surgery. The potential advantages of such techniques may include less postoperative pain, less abdominal wall complications, faster return to activity, and better cosmesis.
Methods: All patients were prospectively included after a written informed consent. The Ethical Board of the Hospital approved the study. All types of bariatric procedures could be theoretically included.
Patients: From April 2008 to March 2011, SILS or NOTES was attempted in 89 selected bariatric patients. Exclusion criteria comprised mainly prior open abdominal surgery, more than 55 Kg/m² BMI, ASA III status, organ insufficiency, hemostasis disorders. The success rate without conversion to laparoscopy or laparotomy was 86.5 % (77 patients). Procedures included Sleeve gastrectomy, adjustable band gastroplasty, adjustable band retrieval, gastric bypass, StomaphyX endoplication, Gastric plication, and miscellaneous.
Results: Mortality rate was nil. The overall complications (mainly minor) rate was 8.9 %. Two patients (2.2 %) were reoperated for bleeding. The median length of stay was 2.9 days (as compared to 4.1 days in a matched series of patients operated by standard laparoscopic techniques) (p<0.05).
Conclusions: SILS and NOTES procedures are safe and feasible in selected patients with morbid obesity. Advantages regarding postoperative pain and length of hospital stay could be demonstrated. However, larger scale, prospective, controlled, randomized studies are needed for further evidence-based analysis.
 

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