Short-term outcomes of single-port versus conventional laparoscopic sleeve gastrectomy: a propensity score matched analysis

Preliminary experience of single-incision laparoscopic placement of adjustable gastric band in adolescents: Safe and feasible

BACKGROUND

Minimally invasive surgery seems particularly suited to adolescents in view of the cosmetic improvements it provides. This study reports on our first experience of single-incision laparoscopic surgery for adjustable gastric banding (SILS-AGB) using a single-trocar approach and evaluates its safety and efficacy as compared with conventional four-trocar laparoscopy.

METHODS

The data of adolescent patients who underwent SILS-AGB or conventional laparoscopy for adjustable gastric banding (CL-AGB) between 2014 and 2019 in our center were reviewed. Pre- and postoperative data on weight- and obesity-associated comorbidities were used to assess the efficacy of the surgical intervention. Perioperative and postoperative data on the duration of surgery, use of analgesics, hospital stay, and complications were compared between the SILS and CL groups along with an assessment of scar quality.

RESULTS

Overall, 12 patients, with a mean body mass index (BMI) of 43.3 kg/m-² (37.0-55.5) at surgery were included in the SILS-AGB group and compared with 14 patients who underwent classic laparoscopy (CL-AGB group) and had an initial BMI of 39.5 kg/m-² (32.0-49.8). Median surgery time was 82 min (55-140) in the CL-AGB group and 106 min (75-159) in the SILS-AGB group (p = 0.04). Postoperative recovery was better in the SILS-AGB group with a mean duration of level-3 intravenous analgesia of 1.8 ± 0.4 days (vs. 2.4 ± 0.6 days, p = 0.02) and a median duration of hospitalization of 2 days (2-3) versus 3 days (2-5) (p = 0.0005). Mid-term follow-up showed equivalent efficacy in terms of weight loss, with a mean BMI at 12 months of 38.5 ± 6.0 kg m-1kg m-1² in both groups, and resolution of hyperinsulinism (92.3 % before surgery vs. 48 % at 6 months).

CONCLUSION

SILS for AGB placement appears to be as safe and effective as CL despite a slightly longer operative time. SILS was associated with faster recovery and better cosmetic results with a single scar.

Single-port sleeve gastrectomy: a comparison between transumbilical and left hypochondrium approaches

BACKGROUND

Left hypochondrium (LHC) approach has been routinely used in our department for performing single-port sleeve gastrectomy (SPSG). Starting from 2019, a transumbilical approach (TU) has been adopted in selected patients. The aim of this study was to report and compare our results of both approaches (LHC and TU) with special focus on incisional hernia (IH).

METHODS

The data of patients who underwent sleeve gastrectomy via both approaches between 2019 and 2022 were retrospectively analyzed. An assessment of IH rate was carried out by reviewing abdominal computed tomography scans performed one year after surgery.

RESULTS

During the study period, 449 patients who underwent SPSG were included in the final analyze. Patients in the TU group (n = 136, 30%) were more frequently female with a lower BMI and fewer comorbidities. An umbilical hernia was observed in 60% of patients in the TU group. Operative duration was longer in the LHC group (80 min vs. 64 min, P < 0.0001). Early complications rates did not differ between the groups (1.9% LHC vs. 0.7% TU, P = 0.353). During follow-up, 65 patients (14%) developed an IH: 9.9% and 25% in the LHC and TU groups, respectively (P < 0.0001). Weight loss and comorbidities resolution at 1 year were globally similar between the two groups.

CONCLUSION

We have demonstrated the feasibility, safety, and efficacy of SPSG via both LHC and TU approaches. The advantage of the LHC approach is its routine applicability. The TU approach offers an esthetic advantage and a shorter operative time but is associated with a much higher IH rate.

Port Site Placement and Outcomes for Surgical Obesity and Metabolic Surgeries (PSPOSO) Checklist: A New Reporting Checklist Based on Evidential Assessment of the Number of Trocars and Positions

Since the early 1980s, efforts to standardize ergonomic practices in laparoscopic surgeries have aimed to improve procedural efficiency and reduce complications, but clinical validation remains limited. In metabolic and bariatric surgeries (MBS), innovations in trocar site placements, driven by the popularity of laparoscopic sleeve gastrectomy (LSG), have advanced surgical techniques. However, practices often vary based on individual surgeon preferences rather than standardized evidence-based criteria. This study introduces the Port Site Placement and Outcomes for Surgical Obesity and Metabolic Surgeries (PSPOSO) checklist, aiming to standardize port placements and improve reporting consistency. A systematic review and meta-analysis of LSG studies were conducted following PRISMA guidelines. Data were extracted from 34 studies involving 7173 cases. Key variables included port configurations, manipulation angles, and outcomes such as operative time and excess weight loss percentage (EWL%). Innovative methods were used to estimate manipulation and azimuth angles from available intraoperative images. Statistical analyses and meta-regression were performed to identify associations between port configurations and surgical outcomes. Findings revealed substantial variability in port placements, with no significant effect of manipulation angles or port numbers on operative time or EWL% at 6, 12, and 24 months (p-values > 0.05). High residual heterogeneity suggests that factors beyond manipulation angles and port counts contribute to outcome variability. The PSPOSO checklist provides a framework for standardizing port placement and ergonomic parameters in MBS, enhancing reproducibility and safety. Future studies should validate the checklist across diverse clinical settings to refine surgical approaches and improve patient outcomes. PROSPERO: CRD42024598674.

Outcomes and Challenges of Transumbilical Single-Port Sleeve Gastrectomy: A Retrospective Analysis Based on Height and BMI

BACKGROUND

Transumbilical single-port sleeve gastrectomy (SPSG) is a minimally invasive bariatric surgery that offers cosmetic benefits. However, the procedure's feasibility in patients with higher BMI or taller stature remains debated. This study evaluates the outcomes of SPSG based on patient height and BMI.

METHODS

We conducted a retrospective analysis of 753 patients who underwent stand-alone SPSG at our hospital between January 2021 and August 2024. Patients' preoperative characteristics, intraoperative data, and postoperative outcomes were collected. We compared operative times, complication rates, and postoperative length of stay between patients with different height and BMI categories.

RESULTS

The mean operative time was significantly longer for patients with a height ≥ 1.8 m (77.5 ± 32.5 min) compared to those < 1.8 m (63.1 ± 26.0 min) (p < 0.05). Similarly, patients with a BMI ≥ 50 kg/m2 had a longer operative time (79.2 ± 32.0 min) than those with a BMI < 50 kg/m2 (62.9 ± 25.9 min) (p < 0.005). No significant difference was observed in the postoperative complications rate and length of stay between the height and BMI groups. The mean 1 year percentage of total weight loss (%TWL) was 31.1 ± 7.1%.

CONCLUSION

SPSG is a feasible procedure for patients with varying heights and BMIs, though it may require longer operative times for certain groups. The procedure's success hinges on the surgeon's expertise and a thorough understanding of patient anatomy. Further research is necessary to optimize single-port techniques and assess long-term outcomes.

Reduced Port Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-analysis

This systematic review evaluated the safety and efficacy of reduced port laparoscopic sleeve gastrectomy and compared its potential advantages over the conventional laparoscopic approach. Eighteen eligible articles were analyzed, including thirteen cohort studies and five randomized trials (n = 2945). There were no differences in total postoperative complications [OR of 0.99 (0.72 to 1.37)] nor those classified as Clavien-Dindo ≥ IIIb. There were also no differences regarding operative time, blood loss, postoperative pain, weight loss, and improvement in comorbidities. In the reduced port group, hospital stay was slightly shorter [WDM of - 0.23 (- 0.39 to - 0.07)], and cosmetic results were better in the short term. Our meta-analysis shows reduced port sleeve gastrectomy can be safely performed in selected patients, although clinical benefits are unclear (PROSPERO (CRD42022372829)).

Single Incision Versus Conventional Multiport Laparoscopic Sleeve Gastrectomy: Meta-Analysis and Systematic Review

Laparoscopic sleeve gastrectomy (LSG) is the most widely performed bariatric surgery and has been associated with excellent outcomes and a significant reduction in obesity-related morbidity and mortality. Traditionally, this surgery is performed using five to seven trocars. However, LSG performed through a single trocar is emerging as a less invasive method of performing this surgery. This systematic review and meta-analysis compare the outcomes and complication rates of single-port versus multi-port LSG. We searched PubMed, Medline, Scopus, and the Cochrane Library for articles published from 2008 to 2023, in accordance with the PRISMA 2020 guidelines. Data on variables such as operative time, excess weight loss, intraoperative bleeding, postoperative leak, and incisional hernia rates were collected and analyzed using a random-effects model. Fourteen articles met the inclusion criteria and were included in the meta-analysis. No significant differences were found between the single-port LSG (SILSG) and conventional LSG (CLSG) groups in terms of operative time, rate, intraoperative complications, length of hospital stay, postoperative complications, and excess weight loss (EWL). Furthermore, single incision sleeve gastrectomy showed better satisfaction with the cosmetic score. SILSG is a viable alternative procedure, showing comparable outcomes to multiport conventional sleeve gastrectomy, in addition, to a better cosmetic satisfaction score.

Short-term outcomes of reduced versus conventional ports in sleeve gastrectomy: A controlled clinical trial

Aim

The study aims to compare the short-term outcomes of reduced ports sleeve gastrectomy versus conventional five ports sleeve gastrectomy in postoperative weight loss, morbidity rate, pain, and resolution of obesity-related diseases.

Materials and Methods

One hundred forty patients were equally allocated to reduced ports (n = 70) and conventional ports (5 ports) Laparoscopic Gastrectomy groups. The primary outcomes are postoperative pain by numeric rating score, cosmetic visual analog score, satisfaction visual analog score, operative time, and hospital stay. The secondary outcomes are postoperative complications and comorbidity resolution.

Results

The numeric rating score for pain assessment was statistically significantly lower in the reduced ports group compared with the conventional ports group at 2, 6, 12, and 24 hours, postoperatively (P < .001). Cosmetic visual analog score was statistically significantly higher in the reduced ports group compared with conventional ports group at 2 and 3 months follow-up (P < .001 and P = .008, respectively). Patient satisfaction visual analog score was statistically significantly higher in the reduced ports group than the conventional ports group at 2 and 3 months follow-up (P < .001 and P = .032, respectively).

Conclusion

Reduced ports laparoscopic sleeve gastrectomy is safe and feasible in patients with body mass index (BMI) up to 50 kg/m2. It is cosmetically well appreciated with noticeable patient satisfaction. It should be practiced with regularity. Further trials should be considered in patients with high BMI (>50 kg/m2).

Magnetic-Assisted Reduced-Port Sleeve Gastrectomy Versus Laparoscopic Sleeve Gastrectomy: a Comparative Study

BACKGROUND

Sleeve gastrectomy is one of the most popular bariatric surgeries. With the advent of new technologies, a reduced-port approach assisted by magnets for sleeve gastrectomy (RPSG-MA) has been developed. The aim of our study is to compare the short-term results of RPSG-MA vs conventional laparoscopic SG (CLSG).

METHODS

A comparative study was performed. We compared two groups who underwent RPSG-MA (n=150) and CLSG (n=135) between January 2020 and January 2022.

RESULTS

Both groups were similar in body mass index, age, sex, and type of comorbidities. The operative time was similar in both groups (RPSG-MA, 52.5 min vs CLSG, 52.9 min; p = 0.829). Length of hospital (1.07 days) stay was significantly shorter in the RPSG-MA group (p = 0.00) than in the CLSG group (1.51 days). There were no conversions to open surgery in any patient or any fatal event. Complications encountered were similar in both groups postoperative. There were minor adverse events directly related to the magnetic device in 3 cases, these being mild hepatic lacerations, resolved with hemostatic measures.

CONCLUSION

The magnet-assisted reduced-port gastric sleeve compared to the conventional technique has proven to be safe, technically feasible and with multiple benefits.

Trocar number and placement for laparoscopic sleeve gastrectomy and comparison of single-incision and conventional laparoscopic sleeve gastrectomy: a systematic review and meta-analysis

BACKGROUND

Conventional laparoscopic sleeve gastrectomy (CLSG) has been conducted in multiple centers for treating morbid obesity, however, there are no standard criteria for (1) placing the trocar; and (2) how many trocars should be used. Single-incision laparoscopic sleeve gastrectomy (SLSG), a newly emerged technique in 2008, has been proposed as an alternative to CLSG in recent years, however, there is no definite evidence for this.

MATERIALS AND METHODS

A systematic literature search was performed using the PubMed, Embase, Web of Science, and Cochrane Library databases for laparoscopic sleeve gastrectomy cases from January 2006 to October 2022. We then summarized the trocar numbers and placement patterns among these studies. A meta-analysis was conducted to compare the difference between SLSG and CLSG in the perioperative and postoperative indices.

RESULTS

A total of 61 studies involving 20 180 patients who underwent laparoscopic sleeve gastrectomy for treating morbid obesity were included in the systematic review, including 11 on SLSG, 35 on CLSG, and 15 studies comparing SLSG and CLSG. A systematic review showed that the trocar number varied in different CLSG studies, mainly using four or five trocars. The trocars were mainly placed in position, presenting an inverted trapezoid pattern and a left-predominant pattern. Meta-analysis showed that the operative time in the SLSG was significantly higher than that in the CLSG, and the pain Visual Analog Scale rating on postoperative day 1 in the CLSG was significantly higher than in the SLSG. There were no statistical significances in the other complications or surgical efficiency.

CONCLUSIONS

In the CLSG, the majority of the trocars were arranged in an inverted trapezoid pattern and were of the left-predominant type. Although SLSG is a feasible technique in selected patients, there is insufficient evidence to recommend its widespread use compared with CLSG. High-quality randomized controlled trials with large study populations and long follow-up periods will be required in the future.

Prevention of incisional hernia after single-port sleeve gastrectomy (PRISM): a prospective non-randomized controlled study

BACKGROUND

SPSG carries a risk of incisional hernia, particularly in patients with high body mass index. Prophylactic mesh placement with either permanent or absorbable mesh could decrease the occurrence of incisional hernia, with uncertainty on other postoperative parietal complications.

METHODS

This is a non-randomized monocentric single-blinded prospective study. High-risk patients (body mass index ≥ 45 kg/m²) underwent either 3 strategies of parietal closure (suture with or without permanent or absorbable mesh) during SPSG. The primary outcome was the occurrence of radiologically defined incisional hernia during the first postoperative year. Secondary outcomes included surgical site infection rates and postoperative pain.

RESULTS

Between November 2018 and November 2019, 255 patients were included (85 in each group). All patients reached one-year postoperative follow-up. Significantly more incisional hernias were observed in the no mesh group in comparison with permanent and absorbable mesh groups, respectively (20% vs. 7.1% vs. 5.1%, P = 0.005). No difference was observed in mesh groups. No difference was observed regarding other parietal complications. One patient in the absorbable mesh group presented a superficial surgical site infection and required surgical drainage without mesh removal and one patient in the permanent mesh group presented a parietal hematoma and required surgical drainage with mesh removal. Twenty-six (92.8%) asymptomatic patients presented incisional hernia discovered on the one-year CT-scan.

CONCLUSIONS

Prophylactic mesh placement during SPSG decreases the occurrence of postoperative incisional hernia. Routine permanent mesh placement could be proposed in high-risk patients.

Safety and effectiveness of reduced-port laparoscopic sleeve gastrectomy in Asian morbidly obese patients

Laparoscopic sleeve gastrectomy is the most frequently performed surgical intervention in patients with morbid obesity. Single-port sleeve gastrectomy (SPSG) and reduced-port sleeve gastrectomy (RPSG) are increasingly reported in the literature. This study compared the short-term outcomes of SPSG, RPSG, and conventional laparoscopic sleeve gastrectomy (CLSG). This is a single-center retrospective study of 238 morbidly obese patients, of whom 148 (62.2%) patients completed follow-up one year after surgery. Propensity score matching was performed on factors influencing the choice of approach, and fifty patients from the SPSG + RPSG and CLSG groups were successfully matched. The groups were comparable in postoperative weight loss, morbidity, pain, and resolution of obesity-related comorbidities. The percentage of excess weight loss after one year was 90.0% in the SPSG + RPSG group and 75.2% in the CLSG group (P < 0.001). Complication rates showed no significant difference. The CLSG group was superior in dyslipidemia remission (17 [37.0%] vs. 28 [63.6%], P = 0.018) in the total cohort; however, this difference disappeared after matching. Our results suggest that single-port and reduced-port approaches could be alternative choices for selected patients. As our study was limited by its retrospective nature and potential selection bias, further studies are necessary to set standardized guidelines for SPSG.

Left Hypochondrium or Transumbilical Single-Incision Laparoscopic Sleeve Gastrectomy for the Treatment of Severe Obesity: Surgical Technique and Results of a Tertiary Referral Bariatric Center

BACKGROUND

Technical aspects of single-incision laparoscopic sleeve gastrectomy (SILSG) vary depending on surgeon's experience and availability of surgical equipment. We have performed more than 3000 SILSGs using standardized technique with left hypochondrium or transumbilical access. The aim of this study is to describe the SILSG technique in a stepwise manner providing technical tips and pitfalls for a left hypochondrium or transumbilical approach and report results of SILSG experience in a tertiary referral bariatric center.

METHODS

A detailed description of left hypochondrium and transumbilical SILSG is provided. Data from all consecutive patients who underwent SILSG between August 2010 and August 2017 were prospectively collected and retrospectively analyzed and reported.

RESULTS

One thousand eight hundred patients underwent SILSG, from which 384 (21.3%) using a transumbilical approach. Mean age was 42.3 years, median BMI 45.3 kg/m², and median operative time 88 min. An additional port was required in 89 patients (4.9%). Postoperative mortality and morbidity rates were 0.05% and 7.5%, respectively. Relaparoscopy and/or endoscopic treatment were required for intra-abdominal bleeding in 27 patients (1.5%) and staple-line leakage in 35 patients (1.9%). Mean excess weight losses were 71.1%, 73.7%, and 70.4% at 1, 2, and 4 years after SILSG, respectively. Two years after SILSG, sustained statistical significant remission of major obesity-related comorbidities was noted. Incisional hernia occurred in 39 patients (2.1%).

CONCLUSIONS

The use of specific instruments allows standardization of left hypochondrium SILSG, which can be routinely performed for the treatment of severe obesity. Transumbilical approach for SILSG should be reserved for well-selected patients and experienced bariatric surgeons.

What Is Weight Loss After Bariatric Surgery Expressed in Percentage Total Weight Loss (%TWL)? A Systematic Review

Percentage total weight loss (%TWL) might be better than percentage excess weight loss to express weight loss in bariatric surgery. In this systematic review, performed according to the PRISMA statement, results of laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) are assessed in %TWL. A total of 13,426 studies were screened and 49 included, reporting data of 24,760 patients. The results show that, despite limiting data, LRYGB is favorable over LSG in terms of weight loss in short-term follow-up. Although recent guidelines recommend to use %TWL when reporting outcome in bariatric surgery, this study shows that there is still insufficient quality data in %TWL, especially on LSG. The use of %TWL as the primary outcome measure in bariatric surgery should be encouraged.