Single-incision and dual-incision laparoscopic adjustable gastric band: evaluation of initial experience.
BACKGROUND
The laparoscopic adjustable gastric band (LAGB) technique has been well described. Most surgeons have used a 4-trocar technique, with an additional incision for a liver retractor. Single incision (SI)-LAGB seeks to further decrease the invasiveness of the procedure. The purpose of the present report was to evaluate the safety and feasibility of SI-LAGB and the effect on the learning curve.


METHODS
All cases performed from October 2008 to October 2009 were reviewed. Both true SI and dual-incision LAGB cases were included. The cases were performed through either a left paramedian or a transumbilical incision. The liver was retracted using the Nathanson retractor or an intracorporeal retractor.


RESULTS
Of the 89 patients studied, 89% were women. Their mean age was 41 ± 12 years (range 19-74), and their body mass index was 46 ± 12 kg/m(2) (range 32-63). The first 27 patients underwent dual-incision LAGB using the Nathanson retractor. The operative time was 45 ± 12 minutes (range 21-90). After the first 35 cases, a reduction in the operative time was observed (P = .03). Simultaneous hiatal hernia repair added an average of 11 minutes of operative time for 40 patients (45%). The conversion rate was 26% for the first 35 cases, 5% for the second 35 cases, and 0% for the last 19 cases. Conversion was represented by adding a 5-mm trocar or the Nathanson retractor. The length of stay was 7 ± 9 hours (range 2-36), and 81 patients (91%) qualified for outpatient surgery. The complications included 1 seroma, 1 reoperation because of band obstruction, and 1 case of esophageal dysmotility after surgery.


CONCLUSIONS
The results of our study have shown that SI-LAGB is a viable alternative to traditional LAGB and can be considered reliable, with low morbidity. The learning curve for consistent completion of SI-LAGB in our experience appeared to be the first 35 cases. We advise standardizing the procedure to facilitate the reproducibility of this technique.
Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA. cgalvani@surgery.arizona.edu
Carlos A
CA
Galvani
Alberto S
AS
Gallo
Maria V
MV
Gorodner
D000328:Adult; D000368:Aged; D004867:Equipment Design; D005260:Female; D015391:Gastroplasty / Q000295:instrumentation / Q000379:methods*; D006551:Hernia, Hiatal / Q000150:complications / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies; D013525:Surgical Instruments