Single-port sleeve gastrectomy, a valuable procedure in the treatment of morbidly obese patients
Background Laparoscopic sleeve gastrectomy has recently been proposed as a sole bariatric procedure because of the considerable weight loss that is achieved in morbidly obese patients. Single-incision laparoscopic sleeve gastrectomy has recently gained acceptance in bariatric surgery as the procedure has possible benefits. The aim of our study was to evaluate the feasibility and safety of a laparoscopic single-incision sleeve gastrectomy for morbid obesity. Patients and methods From January 2011 to March 2014, single-port laparoscopic sleeve gastrectomy through a special single-port silicon device that is flexible and reusable with a novel method for liver retraction was performed on 30 consecutive morbidly obese patients enrolled from Ain Shams University hospitals. The patients were 22 women (73.3%) and eight men (26.7%), mean age 31 years (range: 23-45) years. The patients recruited in this study had a mean BMI of 41.3 kg/m 2 (range: 35-45) kg/m 2 . The operative technique, operative time, postoperative hospital stay, and early and late postoperative complications were monitored, and the percentage of excess weight loss (%EWL), which was measured at 3, 6, and 12 months, respectively, was determined. Results A total of 30 single-incision laparoscopic sleeve gastrectomies were performed. The procedure was performed successfully in 27 patients (90%), with three conversions (10%) to traditional laparoscopic sleeve gastrectomy. The mean operative time was 92 min (range: 80-135) min, whereas the mean hospital stay was 2.4 days (range: 2-4) days. In terms of morbidities, there were six cases of vomiting (20%), one case of wound infection (3.3%), and two cases of incisional hernia (6.6%). The %EWL was 26, 38.3, and 61.43 at 3, 6, and 12 months, respectively. There were no mortalities in our study. Conclusion Laparoscopic single-incision sleeve gastrectomy seems to be safe, technically feasible, and reproducible. Our technique for liver retraction provides adequate exposure. However, additional work must be carried out before these techniques achieve the level of standardization. More flexible articulating instruments, high-illumination, high-magnification, flexible endoscopes, and free-standing insertable retractors need to be developed.