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

BACKGROUND: Single-incision laparoscopic sleeve gastrectomy (SILSG) has been proposed as an alternative to conventional laparoscopic sleeve gastrectomy (CLSG) in obese patients. This study aims to compare the surgical outcomes of these two techniques. METHODS: A meta-analysis of existing literature obtained through a systematic literature search in the PubMed, EMBASE, and Cochrane Library CENTRAL databases from 2009 to 2019 was conducted. RESULTS: Eleven articles including 1168 patients were analyzed. Patients in the SILSG group reported greater satisfaction with cosmetic scar outcomes than those in the CLSG group (SMD = 2.47, 95% CI = 1.10 to 3.83, P = 0.00). There was no significant difference between the SILSG group and the CLSG group regarding operative time, intraoperative estimated blood loss, conversion rate, intraoperative complications, length of hospital stay, postoperative analgesia, postoperative complications, excess weight loss (EWL), and improvements in comorbidities (P > 0.05). CONCLUSIONS: Compared to CLSG, SILSG resulted in improved cosmetic satisfaction and showed no disadvantages in terms of surgical outcomes; thus, SILSG can serve as an alternative to CLSG for obese patients. Nonetheless, high-quality randomized controlled trials (RCTs) with large study populations and long follow-up periods are needed.

Evolution and Standardisation of Techniques in Single-Incision Laparoscopic Bariatric Surgery.

Bariatric surgery has proven benefits for morbid obesity and its associated comorbidities. Laparoscopic approach is well established for bariatric surgery. Single-incision laparoscopic surgery (SILS) offers even more minimally invasive approach for the same with the added advantage of better cosmesis. We have developed and standardised the SILS approach at our institute. We share our experience and technical "tips" and modifications which we have learnt over the years. Technical details of performing sleeve gastrectomy and Roux-en-Y gastric bypass with special attention to liver retraction, techniques of dissection in difficult areas, creation of anastomoses and suturing have all been described. In our experience and in experience of others, single-incision bariatric surgery is feasible. Use of conventional laparoscopic instruments makes single-incision approach practical for day-to-day practice. Supervised training is essential to learn these techniques.

Single Incision Versus Conventional Laparoscopic Sleeve Gastrectomy for Morbid Obesity: A Meta-Analysis.

INTRODUCTION: The purpose of this study was to review the existing evidence on obese patients treated with single-incision laparoscopic sleeve gastrectomy (SILSG) or conventional laparoscopic sleeve gastrectomy (LSG), to compare the perioperative parameters and outcomes of the two bariatric procedures. MATERIALS AND METHODS: A systematic literature search was performed in PubMed, Scopus, and Cochrane library, in accordance with the PRISMA guidelines. Seventeen articles met the inclusion criteria and incorporated 3843 patients. RESULTS: This study reveals comparable mean operative time, length of hospital stay, and complications between the two approaches. The SILSG approach was associated with enhanced cosmetic results, but increased incisional hernia rate. CONCLUSIONS: These outcomes should be treated with caution given the small number of included comparative studies. Well-designed, randomized controlled studies, comparing LSG to SILSG, are necessary to assess further their clinical outcomes.

Single-Incision Laparoscopic Sleeve Gastrectomy: Review and a Critical Appraisal.

BACKGROUND: Single-incision laparoscopic surgery has attracted a great deal of interest in the surgical community in recent years, including bariatric surgery. Single-incision laparoscopic sleeve gastrectomy (SILSG) has been proposed as an alternative to the multiport laparoscopic procedure; however, it has yet to meet wide acceptance and application. OBJECTIVE: We aim to summarize existing data on SILSG and check the procedure's feasibility, technical details, safety, and, if possible, outcomes. MATERIALS AND METHODS: We checked the most important databases for studies concerning SILSG and included all these that summarized the criteria placed and contained the data needed for this review. We excluded case reports. RESULTS: Nineteen studies complied with the criteria of our review, containing a total of 1679 patients. Their mean age has been 38.91 years and the mean preoperative body mass index has been 41.8 kg/m2. In majority of cases (60.5%), a left upper quadrant incision has been preferred and in 97.6%, a commercially available multiport system has been picked. A wide variety of instruments have been used and mean operating time has been 94.6 minutes. One conversion to open surgery has been reported and 7.4% required the placement of additional ports. There was a complication rate of 7.38% (most common being bleeding with a rate of 2.5%) and a reoperation rate of 2.8%. Mean excess weight loss for a follow-up of 1 year was achieved in 53.7% of patients and was 70.06%. A tendency for less analgesia and better wound satisfaction has been reported. CONCLUSIONS: SILSG is safe and feasible. However, there is insufficient evidence to recommend it as the new gold standard for sleeve gastrectomy in the place of conventional laparoscopic sleeve gastrectomy. Randomized controlled trials are needed to analyze the results and the possible benefits of this technique.

Single-incision laparoscopic bariatric surgery: a systematic review.

BACKGROUND: Single-incision laparoscopic surgery has sparked a great deal of interest in the surgical community in recent years, including bariatric surgery. However, we still do not definitively know if this type of surgical approach provides benefits over conventional techniques without increasing morbidity and mortality. OBJECTIVE: To evaluate the safety and efficacy of single-incision laparoscopic bariatric surgery (SILBS) compared with conventional laparoscopic bariatric surgery (CLBS). MATERIALS AND METHODS: We searched the most important databases. Randomized clinical trials and observational studies comparing SILBS with CLBS were included. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. RESULTS: Fourteen studies complied with the inclusion criteria for our analysis, which included 2357 patients (1179 SILBS group versus 1178 CLBS group). The duration of surgery was longer in the SILBS group and no major intraoperative complications were observed in these series. A small improvement in postoperative pain was indicated in the SILBS group. The overall morbidity rate was 5% in the SILBS group and 4.8% in the CLBS. There was 1 perioperative death in 1 study, which occurred in an adjustable gastric banding (AGB) group, at .1% of all cases of AGB and .005% of all SILBS cases. When cosmesis was evaluated, patients in the SILBS group were more satisfied with the scar outcome. CONCLUSION: SILBS is a feasible technique to use in selected patients. However, there is insufficient evidence to recommend its widespread use compared with a conventional approach. More studies are needed to analyze the safety of this technique and its possible benefits.