Single-incision laparoscopic sleeve gastrectomy: initial experience in 20 patients and 2-year follow-up

BACKGROUND: The transumbilical route began being clinically feasible with or without unique access devices. SETTING: The setting for this study was a private practice at Clínica Las Condes, Santiago, Chile. OBJECTIVE: The objective was to describe our experience performing a laparoscopic sleeve gastrectomy (LSG) via transumbilical route using a single-port access device in addition to standard laparoscopic instruments. METHOD: A prospective nonrandomized protocol was applied to patients fulfilling the following inclusion criteria: to have been medically indicated for an LSG, to have a body mass index (BMI) of less than or equal to 40 kg/m(2), and the distance between the xiphoid appendix and umbilicus should be less than 22 cm. All patients were female with a median (p50) age of 34.5 (ranging from 21 to 57) years, a median weight of 92 (ranging from 82.5 to 113) kg, and a median BMI of 35.1 (ranging from 30.5 to 40) kg/m(2). The device insertion technique, the gastrectomy, and postoperative management are described. RESULTS: LSG via transumbilical route was successfully carried out in 19 of the 20 patients in whom the procedure was performed; one patient had to be converted to a conventional laparoscopic procedure. Mean operating time was 127 (ranging from 90 to 170) min. On the second postoperative day, all patients were assessed through an upper gastrointestinal barium-contrasted radiological series. There was neither morbidity nor mortality in this group. Excess weight loss at 25 months after surgery was 114 %. CONCLUSIONS: Single-port LSG can be successfully performed in selected obese patients with a BMI of less than 40 kg/m(2) using traditional laparoscopic instruments. The technique allows performing a safe and effective vertical gastrectomy.