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Consecutive Versus Selective Primary and Revisional Single Incision Laparoscopic Bariatric Surgery: Personal
Elie Chelala1,2,3, Wissam El Hajj Moussa4,5, Simon Rizk4,5
1General Surgery Department, University Hospital Notre Dame des Secours, Byblos, Lebanon. elie.chelala@chu-nds.org.
Obesity Surgery
|December 21, 2019
Summary
This study evaluated single-incision laparoscopic surgery (SILS) for bariatric procedures, finding selective SILS safer and more efficient than consecutive SILS. Incisional hernia rates were higher with SILS, requiring careful consideration of cosmetic benefits versus risks.
Area of Science:
- Surgical Innovation
- Minimally Invasive Surgery
- Bariatric Surgery
Background:
- Single-incision laparoscopic surgery (SILS) is increasingly explored for bariatric procedures.
- Evaluating SILS feasibility, safety, and standardization is crucial for widespread adoption.
- Analysis of incisional hernia prevalence and technical factors in SILS is needed.
Purpose of the Study:
- To retrospectively assess the feasibility, safety, and standardization of consecutive and revisional SILS bariatric surgeries.
- To analyze the prevalence of incisional hernias following SILS procedures.
- To identify technical improvements and limiting factors in SILS bariatric surgery.
Main Methods:
- Retrospective database review of 330 SILS bariatric surgeries (Part I: 290 consecutive cases, Part II: 40 selective cases).
- Inclusion of primary and revisional gastric bypass procedures.
- Standardization and training of the trans-umbilical technique in Part II.
Main Results:
- Successful completion of SILS in all 330 cases, with minimal need for additional trocars (2.75-3.1%).
- No deaths or conversions; early complications included one fistula and two perforations requiring reoperation.
- Late complications included internal hernias (1.03-5%) and incisional hernias (4.1-12.5%).
Conclusions:
- Standardized selective SILS demonstrates superiority over consecutive SILS regarding morbidity, operative time, and trocar salvage.
- The cosmetic advantage of SILS must be balanced against cost-effectiveness and the higher midterm rate of umbilical port site incisional hernias.
