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Single-incision and dual-incision laparoscopic adjustable gastric band: evaluation of initial experience
Carlos A Galvani1, Alberto S Gallo, Maria V Gorodner
1Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA. cgalvani@surgery.arizona.edu
Background:
The laparoscopic adjustable gastric band (LAGB) technique has been well described. Most surgeons have used a 4-trocar technique, with an additional incision for a liver retractor. Single incision (SI)-LAGB seeks to further decrease the invasiveness of the procedure. The purpose of the present report was to evaluate the safety and feasibility of SI-LAGB and the effect on the learning curve.
Methods:
All cases performed from October 2008 to October 2009 were reviewed. Both true SI and dual-incision LAGB cases were included. The cases were performed through either a left paramedian or a transumbilical incision. The liver was retracted using the Nathanson retractor or an intracorporeal retractor.
Results:
Of the 89 patients studied, 89% were women. Their mean age was 41 ± 12 years (range 19-74), and their body mass index was 46 ± 12 kg/m(2) (range 32-63). The first 27 patients underwent dual-incision LAGB using the Nathanson retractor. The operative time was 45 ± 12 minutes (range 21-90). After the first 35 cases, a reduction in the operative time was observed (P = .03). Simultaneous hiatal hernia repair added an average of 11 minutes of operative time for 40 patients (45%). The conversion rate was 26% for the first 35 cases, 5% for the second 35 cases, and 0% for the last 19 cases. Conversion was represented by adding a 5-mm trocar or the Nathanson retractor. The length of stay was 7 ± 9 hours (range 2-36), and 81 patients (91%) qualified for outpatient surgery. The complications included 1 seroma, 1 reoperation because of band obstruction, and 1 case of esophageal dysmotility after surgery.
Conclusion:
The results of our study have shown that SI-LAGB is a viable alternative to traditional LAGB and can be considered reliable, with low morbidity. The learning curve for consistent completion of SI-LAGB in our experience appeared to be the first 35 cases. We advise standardizing the procedure to facilitate the reproducibility of this technique.
