Skip to main content
Log in

Laparoscopic Bariatric Surgery Can Be Performed Through a Single Incision: A Comparative Study

  • New Concept
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

The application of single-incision laparoscopic surgery (SILS) in bariatric patients has been limited to less complex procedures. We evaluated the short-term outcomes of SILS sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), compared to a group of well-established minimally invasive techniques.

Methods

Twenty-eight morbidly obese patients who underwent SILS SG (n = 14) and RYGB (n = 14) were compared to a matched control group composed of 28 cases of conventional laparoscopic surgery (CLS). A single vertical 2.5–3-cm intra-umbilical incision, three-ports placed trans-fascially, and a liver suspension technique were used to perform SILS.

Results

Both groups were comparable in terms of age (p = 0.96), gender (p = 1.0), type of procedure (p = 1.0), and number of comorbidities (p = 0.63). Two (7 %) SILS patients required placement of one additional port, and no conversions to CLS or open surgery were needed. The estimated blood loss (p = 0.48), operative time (p = 0.33), length of hospital stay (p = 0.79), overall 90-day perioperative complication rate (p = 1.0), and short-term weight loss (p = 0.53) were comparable between the two groups. In terms of pain control, the frequency of patient-controlled analgesia use in both groups was similar. However, the pain score (assessed by visual analog scale) was significantly less for SILS patients on postoperative days 1 (5.0 ± 2.1 vs. 6.5 ± 1.8; p = 0.007) and 2 (4.0 ± 2.0 vs. 5.1 ± 2.4; p = 0.49). Cosmetic satisfaction with the scar was high in the SILS group. No patients required reoperation or readmission during the 90 days after surgery.

Conclusion

SILS is feasible in carefully selected bariatric patients and results in short-term outcomes comparable to those observed after CLS. Improved pain and cosmesis are potential benefits of SILS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Reoch J, Mottillo S, Shimony A. Safety of laparoscopic vs. open bariatric surgery: a systematic review and meta-analysis. Arch Surg. 2011;146(13):1314–22.

    Article  PubMed  Google Scholar 

  2. Huang CK, Lo CH, Houng JY, et al. Surgical results of single-incision transumbilical laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2012;8(2):201–7.

    Article  PubMed  Google Scholar 

  3. Nguyen NT, Smith BR, Reavis KM, et al. Strategic laparoscopic surgery for improved cosmesis in general and bariatric surgery: analysis of initial 127 cases. J Laparoendosc Adv Surg Tech A. 2012;22(4):355–61.

    Article  PubMed  Google Scholar 

  4. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:240–52.

    Article  Google Scholar 

  5. Huang C. Single-incision laparoscopic bariatric surgery. J Minim Access Surg. 2011;7(7):99–103.

    PubMed Central  PubMed  Google Scholar 

  6. Park K, Afthinos JN, Razi SS, et al. Laparoendoscopic single-site surgery for the placement of an adjustable gastric band: a large cohort comparison. Surg Obes Relat Dis. 2013;9(5):1695–700.

    Article  Google Scholar 

  7. Chakravartty S, Murgatroyd B, Ashton D, et al. Single and multiple incision laparoscopic adjustable gastric banding: a matched comparison. Obes Surg. 2012;22(11):1695–700.

    Article  PubMed  Google Scholar 

  8. Patel AG, Murgatroyd B, Ashton WD. Single incision laparoscopic adjustable gastric banding: 111 cases. Surg Obes Relat Dis. 2012;8(6):747–51.

    Article  PubMed  Google Scholar 

  9. Mittermair R, Pratschke J, Sucher R. Single-incision laparoscopic sleeve gastrectomy. Am Surg. 2013;79(4):393–7.

    PubMed  Google Scholar 

  10. Fernández JI, Ovalle C, Farias C, et al. Transumbilical laparoscopic Roux-en-Y gastric bypass with hand-sewn gastrojejunal anastomosis. Obes Surg. 2013;23(1):140–4.

    Article  PubMed  Google Scholar 

  11. Reavis KM, Hinojosa MW, Smith BR, et al. Single-laparoscopic incision transabdominal surgery sleeve gastrectomy. Obes Surg. 2008;18(11):1492–4.

    Article  PubMed  Google Scholar 

  12. Saber AA, Elgamal MH, Itawi EA, et al. Single incision laparoscopic sleeve gastrectomy (SILS): a novel technique. Obes Surg. 2008;18(10):1338–42.

    Article  PubMed  Google Scholar 

  13. Huang CK, Tsai JC, Lo CH, et al. Preliminary surgical results of single-incision transumbilical laparoscopic bariatric surgery. Obes Surg. 2011;21(3):391–6.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Huang CK, Yao SF, Lo CH, et al. A novel surgical technique: single-incision transumbilical laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2010;20(10):1429–35.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Varela JE. Single-site laparoscopic sleeve gastrectomy: preclinical use of a novel multi-access port device. Surg Innov. 2009;16(3):207–10.

    Article  PubMed  Google Scholar 

  16. Merchant AM, Cook MW, White BC, et al. Transumbilical Gelport access technique for performing single incision laparoscopic surgery (SILS). J Gastrointest Surg. 2009;13(1):159–62.

    Article  PubMed  Google Scholar 

  17. Morales-Conde S, Dominguez G, Cañete Gomez J, et al. Magnetic-assisted single-port sleeve gastrectomy. Surg Innov. 2013; 20, doi:10.1177/1553350611427548.

  18. Koh CE, Martin DJ, Cavallucci DJ, et al. On the road to single-site laparoscopic adjustable gastric banding: lessons learned from 60 cases. Surg Endosc. 2011;25(3):947–53.

    Article  PubMed  Google Scholar 

  19. Huang CK, Lo CH, Asim S, et al. A novel technique for liver retraction in laparoscopic bariatric surgery. Obes Surg. 2011;21(5):676–9.

    Article  PubMed  Google Scholar 

  20. Alevizos L, Lirici MM. Laparo-endoscopic single-site sleeve gastrectomy: results from a preliminary series of selected patients. Minim Invasive Ther Allied Technol. 2012;21(1):40–5.

    Article  PubMed  Google Scholar 

  21. Marks JM, Phillips MS, Tacchino R, et al. Single-incision laparoscopic cholecystectomy is associated with improved cosmesis scoring at the cost of significantly higher hernia rates: 1-year results of a prospective randomized, multicenter, single-blinded trial of traditional multiport laparoscopic. J Am Coll Surg. 2013;216(6):1047–8. discussion 1047–8.

    Article  Google Scholar 

  22. Lakdawala MA, Muda NH, Goel S, et al. Single-incision sleeve gastrectomy versus conventional laparoscopic sleeve gastrectomy—a randomised pilot study. Obes Surg. 2011;21(11):1664–70.

    Article  PubMed  Google Scholar 

  23. Jolley J, Ahmed N, Luu MB, et al. Single-incision versus conventional laparoscopic adjustable gastric banding. JSLS. 2013;17(3):385–7.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Conflict of Interest

Tomasz Rogula, Christopher Daigle, Monica Dua, Hideharu Shimizu, Jonathan Davis, Olga Lavryk, Ali Aminian, and Philip Schauer declare no conflict of interest.

Funding

None

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tomasz Rogula.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rogula, T., Daigle, C., Dua, M. et al. Laparoscopic Bariatric Surgery Can Be Performed Through a Single Incision: A Comparative Study. OBES SURG 24, 1102–1108 (2014). https://doi.org/10.1007/s11695-014-1291-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-014-1291-1

Keywords

Navigation