Comparison of Single-Incision and Conventional Laparoscopic Sleeve Gastrectomy for Morbid Obesity: a Meta-Analysis

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)).

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.

Multisite study of Titan SGS stapler in longitudinal gastric resection

Background

Standardization of the laparoscopic sleeve gastrectomy procedure is needed to improve patient outcomes. A single-fire 23 cm stapler was developed to streamline the operation. Comparative testing conducted on excised human tissue has demonstrated the superiority of the novel Titan SGS stapler to two commonly utilized commercial devices in both staple line integrity and burst pressure. We hypothesized that the stapler would be safe and effective in creating longitudinal gastric resections in human patients.

Methods

61 patients were enrolled to undergo gastric resection with the Titan SGS stapler. Perioperative interventions and post-operative adverse events were recorded. Upper GI study was completed on post-operative day 1, and patients were followed for 6 weeks post-operatively to determine any subacute device-related adverse events.

Results

Surgeon feedback for intraoperative device utilization and post-operative gastric pouch shape were positive. Adverse events were found to be mild, limited, and generally well-known effects of bariatric surgery. One episode of post-operative hemorrhage required surgical takeback, with no criminal bleeding vessel identified.

Conclusion

The Titan SGS stapler is both safe and effective in sleeve gastrectomy pouch creation.