Outcome Analysis of Single Incision vs Traditional Multiport Sleeve Gastrectomy: A Matched Cohort Study

Gomberawalla, Ameer; Salamat, Arsalan; Lutfi, Rami

doi:10.1007/s11695-014-1312-0

Cited by 21 publications

(3 citation statements)

References 16 publications

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“…After removing duplicates (n = 79), the 1554 records were screened by title and abstract after which 1179 were excluded and the full-text articles for the remaining 375 records were assessed for eligibility. A total of 148 papers were included in the final analysis and the number of studies per reinforcement method were: 69 for NO-SLR [9, 17-84], 70 for suture [9,19,20,22,26,30,46,51,53,75,76,78,83,, 9 for BPS [9,72,78,83,86,89,[141][142][143], 9 for Seal [9,30,61,74,78,103,[144][145][146], and 24 for APM [9,39,52,53,63,89,103,131,[147][148][149][150][151][152][153][154][155][156][157][158][159][160]…”

Section: Study Characteristicsmentioning

confidence: 99%

Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review

2019

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Background Staple-line leaks following laparoscopic sleeve gastrectomy (LSG) remain a concerning complication. Stapleline buttressing is largely adopted as an acceptable reinforcement but data regarding leaks have been equivocal. This study compared staple-line leaks in five reinforcement options during LSG: no reinforcement (NO-SLR), oversewing (suture), nonabsorbable bovine pericardial strips (BPS), tissue sealant or fibrin glue (Seal), or absorbable polymer membrane (APM). Methods This systematic review study of articles published between 2012 and 2016 regarding LSG leak rates aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Variables of interest included leak rates, bleeding, and complications in addition to surgical and population parameters. An independent Fisher's exact test was used to compare the number of patients with and without leaks for the different reinforcement options. Results Of the 1633 articles identified, 148 met inclusion criteria and represented 40,653 patients. Differences in age (older in APM; p = 0.001), starting body mass index (lower in Suture; p = 0.008), and distance from pylorus (closer in BPS; p = 0.04) were observed between groups, but mean bougie size was equivalent. The overall leak rate of 1.5% (607 leaks) ranged from 0.7% for APM (significantly lower than all groups; p ≤ 0.007 for next lowest leak rate) to 2.7% (BPS). Conclusions This systematic review of staple-line leaks following LSG demonstrated a significantly lower rate using APM staple-line reinforcement as compared to oversewing, use of sealants, BPS reinforcement, or no reinforcement. Variation in surgical technique may also contribute to leak rates.

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Section: Study Characteristicsmentioning

confidence: 99%

Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review

2019

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“…4 A and B). Moreover, seven studies 60 , 62 – 67 , 69 , 71 reported the EWL at 6 months postoperatively, eight studies 62 , 63 , 65 , 67 – 71 reported the EWL at 12 months postoperatively, and only four studies 63 , 65 , 67 , 68 reported the EWL at 24 months postoperatively. The EWL at 6, 12, and 24 months postoperatively showed no statistical differences between the SLSG and CLSG (Figs.…”

Section: Resultsmentioning

confidence: 99%

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

Jiang

Zhang

Feng

et al. 2023

International Journal of Surgery

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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.

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“…Mittermair et al proposed limiting SPSG to patients with a BMI of < 45 kg/m 2 32 . Hiatal hernia, GERD, extremely high BMI (> 40 kg/m 2 ), and previous upper gastrointestinal surgery were suggested contraindications 9 , 33 . Our study set the recommended indication for SPSG as female patients with BMI ≤ 42 kg/m 2 and no history of upper abdominal surgery except for laparoscopic cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

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

Park

Lee

et al. 2021

Sci Rep

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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.

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Outcome Analysis of Single Incision vs Traditional Multiport Sleeve Gastrectomy: A Matched Cohort Study

Abstract: Sleeve gastrectomy can be performed safely using single incision techniques with equivalent outcomes for weight loss.

Cited by 21 publications

References 16 publications

Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review

Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review

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

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

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