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The left subcostal incision revisited

¹Surgery, LSU Medical Center, Shreveport, USA.

Obesity Surgery

|September 8, 1998

Summary

The left subcostal incision is a safe and effective approach for open bariatric surgery, including gastroplasty and Roux-en-Y gastric bypass. This method demonstrates low complication rates, supporting its use as a gold standard.

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Area of Science:

Bariatric Surgery
Surgical Incisions
Obesity Treatment

Background:

The left subcostal incision has been exclusively used for gastroplasty (GP) and Roux-en-Y gastric bypass (RYGBP) since 1979.
This approach has demonstrated complication rates superior to those reported for midline incisions in existing literature.

Purpose of the Study:

To evaluate the efficacy and safety of the left subcostal incision in bariatric surgery.
To compare complication rates associated with the left subcostal incision against historical data.

Main Methods:

A retrospective analysis of 1840 bariatric procedures (1798 primary, 42 conversions) performed via left subcostal incision from July 1979 to March 1997.
Data collection focused on complication rates including incision hernias, dehiscence, splenectomy, and wound healing issues.

Main Results:

Low incidence of major complications: 0.16% incision hernias, 0.2% dehiscence, and 0.16% splenectomies (none since 1983).
Overall wound healing problems were infrequent, occurring in 2.2% of cases.
No significant changes in complication rates were observed compared to an earlier series.

Conclusions:

The left subcostal incision is a reliable and safe surgical approach for open bariatric procedures.
The author advocates for the left subcostal incision to be considered the gold standard for open bariatric surgery.

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