title: Traditional versus single-site placement of adjustable gastric banding: a comparative study and cost analysis.
abstract: In bariatric surgery, laparoscopic adjustable gastric banding (LAGB) has proven effective in reducing weight and improving obesity-associated comorbidities. Recently, however, laparoendoscopic single-site (LESS) surgery has been proposed to minimize the invasiveness of laparoscopic surgery. The aim of this study is to compare the operative cost and peri-operative outcomes of these two approaches. We undertook a retrospective review of a prospectively maintained database of patients undergoing either LAGB or LESS between March 2006 and October 2009. The outcomes and cost of 25 LESS gastric bandings were compared to 121 standard LAGB. Costs included operative time, consumables, and laparoscopic tower depreciation. Both groups had similar patient demographics, body mass index, and comorbidities; with the exception of age (37 year for single site vs. 44 years for standard; P=0.002). There were no statistical differences for operative time (78 vs. 76 min, P=0.69), blood loss (8.4 vs. 9 ml, P=0.76), pain score (0.81 vs. 0.84 at 1 week, P=0.95) or complication rates (12% vs. 14%, P=1). Length of stay was shorter for the LESS group (0.5 day vs. 1.5 days, P=0.02). The mean operative cost for the LESS banding was $20,502/case vs. $20,346/case for the standard LAGB, with no statistically significant difference between the approaches (P=0.73). Operative costs and peri-operative outcomes of LESS gastric banding are comparable with those of the standard LAGB procedure. As a result, single-site surgery can be proposed as a valid alternative to the standard procedure with cosmetic advantage and comparable complication rate.
authors.affiliation: Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435 E, Chicago, IL 60612, USA. ayloosub@uic.edu
authors.forename: Subhashini M
authors.initials: SM
authors.lastname: Ayloo
authors.forename: Nicolas C
authors.initials: NC
authors.lastname: Buchs
authors.forename: Pietro
authors.initials: P
authors.lastname: Addeo
authors.forename: Francesco M
authors.initials: FM
authors.lastname: Bianco
authors.forename: Pier C
authors.initials: PC
authors.lastname: Giulianotti
mesh_terms: D000328:Adult; D005260:Female; D015391:Gastroplasty / Q000191:economics* / Q000379:methods; D017048:Health Care Costs; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D010147:Pain Measurement; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
references.citation: Obes Surg. 2009 Dec;19(12):1707-10
references.pmid: 19579051
references.citation: Surgery. 2008 Dec;144(6):995-1001; discussion 1001
references.pmid: 19041009
references.citation: Obes Surg. 2010 Feb;20(2):236-9
references.pmid: 19847575
references.citation: Surg Obes Relat Dis. 2009 May-Jun;5(3):362-4
references.pmid: 19460675
references.citation: Surg Obes Relat Dis. 2008 Jan-Feb;4(1):26-32
references.pmid: 18069075
references.citation: Am J Manag Care. 2008 Sep;14(9):589-96
references.pmid: 18778174
references.citation: Obes Surg. 2008 Dec;18(12):1628-31
references.pmid: 18830779
references.citation: J Am Coll Surg. 2009 Nov;209(5):632-7
references.pmid: 19854405
references.citation: Obes Surg. 2009 Oct;19(10):1447-55
references.pmid: 19655209
references.citation: Endoscopy. 2008 Jul;40(7):581-3
references.pmid: 18609452
references.citation: Eur Urol. 2010 Jan;57(1):95-101
references.pmid: 19664877
references.citation: Int J Surg. 2009 Oct;7(5):456-9
references.pmid: 19616651
references.citation: Surg Obes Relat Dis. 2009 Mar-Apr;5(2):150-5
references.pmid: 18849200
references.citation: J Laparoendosc Adv Surg Tech A. 2003 Aug;13(4):257-63
references.pmid: 14561254
references.citation: Surg Obes Relat Dis. 2010 Sep-Oct;6(5):503-7
references.pmid: 19969508
references.citation: Colorectal Dis. 2010 Sep;12(9):941-3
references.pmid: 19895601
references.citation: Int J Colorectal Dis. 2008 Oct;23(10):1013-6
references.pmid: 18607608
references.citation: J Gastrointest Surg. 2010 Feb;14(2):404-7
references.pmid: 19908104
references.citation: World J Surg. 2009 May;33(5):1015-9
references.pmid: 19116734
references.citation: Urology. 2010 Jan;75(1):100-3
references.pmid: 19628259
references.citation: Eur Urol. 2009 May;55(5):1198-204
references.pmid: 18715694
references.citation: Surg Obes Relat Dis. 2010 Jan-Feb;6(1):41-5
references.pmid: 19560980
references.citation: Ann Surg. 2009 Oct;250(4):631-41
references.pmid: 19730234
references.citation: Surg Endosc. 2009 Jul;23(7):1667-70
references.pmid: 19466494
references.citation: Surg Endosc. 2009 Jun;23(6):1409-14
references.pmid: 19288157
references.citation: World J Surg. 2009 Oct;33(10):2039-48
references.pmid: 19551427
references.citation: J Am Coll Surg. 2009 Nov;209(5):638-44
references.pmid: 19854406
references.citation: Postgrad Med J. 2007 Jan;83(975):8-15
references.pmid: 17267672
references.citation: Colorectal Dis. 2010 Jan;12(1):61-5
references.pmid: 19320667
references.citation: JSLS. 2009 Oct-Dec;13(4):528-35
references.pmid: 20202394
references.citation: Surg Obes Relat Dis. 2010 Mar 4;6(2):132-7
references.pmid: 19926528
references.citation: Obes Surg. 1991 Sep;1(3):257-265
references.pmid: 10775921
references.citation: Obes Surg. 2009 Oct;19(10):1442-6
references.pmid: 19830506
references.citation: Ann Surg. 2006 Apr;243(4):486-91
references.pmid: 16552199