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Consecutive Versus Selective Primary and Revisional Single Incision Laparoscopic Bariatric Surgery: Personal Experience in 330 Cases

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Abstract

Background

This paper aims to retrospectively evaluate the feasibility, safety, and standardization for both consecutive primary and revisional SILS bariatric surgeries, and to analyze incisional hernia’s prevalence, technical improvements, and limiting factors.

Methods

A retrospective database review was undertaken involving, in Part I (Belgium), 290 consecutive SILS, including 80.68% primary bariatric surgeries, and 19.32% revisional gastric bypass, followed in Part II (Lebanon), by 40 selective primary SILS. Training for and standardization of the trans-umbilical technique was done for the operating room team, and was executed in part II.

Results

The procedure of single incision was successfully completed in all of the 330 cases part I & part II. There was a need for additional salvage for one or two trocars in respectively 3.1% and 2.75% of the cases. There were no deaths or conversions in either group. Early complications included one medically healed fistula after revisional GB, and two secondary gastric and intestinal perforation requiring reoperations. Late surgical complications were: “3 patients (1.03%) in Part I and 2 (5%) in Part II suffered occlusions, requiring laparoscopic mesenteric defect’s closure on an internal herniation.” Twelve patients (4.1%) from part I and 5 (12.5%) in part II suffered an incisional hernia.

Conclusion

Selective SILS, when standardized, tends to be superior to consecutive SILS in terms of overall morbidity, operative time, and need for additional salvage trocars. Cost effectiveness and higher midterm rate of umbilical port site incisional hernia should be weighed against the beneficial cosmetic effect for the patient.

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Acknowledgments

Authors would like to thank the coworkers and residents Dr. Julie Estievenart and Dr. Celine Bombeck for the database collected at CHU Tivoli, and Dr. JL Allé, head of the surgery departement, for the cooperation and the development of the SILS activity at CHU Tivoli. Finally, I would like to thank tremendously Pr. Jacques Himpens for the review and advice provided in the elaboration of this article and Dr. Souheil Hallit from USEK, for his rich input in the statistics analysis of the manuscript review.

Legend Abbreviations

SILS-GB Single incision Laparoscopic Gastric Bypas.

BPD Biliopancreatic diversion.

SADI-S Single anastomosis duodeno ileal-sleeve gastrectomy.

SILS-RYGB Single incision laparoscopic Roux-en-Y Gastric Bypass.

HTN Blood hypertension.

SAS Sleep apnea syndrome.

DM II Diabetes mellitus type II.

SG Sleeve Gastrectomy.

DS Duodenal Switch.

GB Gastric Bypass.

R Revisional.

P Primary.

SILS Single Incision Laparoscopic Surgery.

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Authors and Affiliations

  1. General Surgery Department, University Hospital Notre Dame des Secours, Byblos, Lebanon

    Elie Chelala, Wissam El Hajj Moussa, Simon Rizk & Nidal Assaker

  2. Faculty of medicine and medical sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon

    Elie Chelala, Wissam El Hajj Moussa, Simon Rizk & Nidal Assaker

  3. General Surgery Department, University Hospital of Tivoli, La Louvière, Belgium

    Elie Chelala

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  1. Elie Chelala
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Contributions

EC declares that he has been a consultant surgeon for Covidien-Medtronic with rewarded scientific activities.

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Correspondence to Elie Chelala.

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For this retrospective review and analysis, the inform consent is not required.

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Chelala, E., El Hajj Moussa, W., Rizk, S. et al. Consecutive Versus Selective Primary and Revisional Single Incision Laparoscopic Bariatric Surgery: Personal Experience in 330 Cases. OBES SURG 30, 1515–1526 (2020). https://doi.org/10.1007/s11695-019-04356-8

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