title: Single-incision transumbilical (SITU) surgery after SITU laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Recently, single-incision transumbilical (SITU) laparoscopic bariatric surgery has been adopted as an alternative option for treating morbid obesity. Patients prefer SITU because it leaves minimal scarring. However, second surgery after SITU is a new challenge for surgeons. Here, we report on the safety and results for patients at a university hospital who underwent second surgery with the SITU procedure after SITU-laparoscopic Roux-en-Y gastric bypass (LRYGB).
  
  
  METHODS
  From November 2008 to May 2011, in total, 78 morbidly obese patients underwent SITU-LRYGB. After follow-up, 7 cases required reoperation with the SITU procedure because of dilated gastrojejunostomy in 1 patient, intractable hiccups in 1 patient, gallstones in 2 patients, and internal hernia from Petersen's defect in the remaining 3 patients. SITU was repeated via the previous umbilical incision to avoid creating a new scar. Three trocars were inserted separately, and pneumoperitoneum was created. The surgical procedures were performed with straight instruments. All surgical results and complications were recorded.
  
  
  RESULTS
  The procedure was successfully completed in all 7 patients without addition of trocars or conversion to conventional LRYGB or open procedure. Mean surgical time was 63±23 minutes. There were no intraoperative complications or postoperative wound complications noted in 3 months of follow-up.
  
  
  CONCLUSIONS
  Second surgery can be successfully done via a single umbilical incision after SITU-LRYGB, with reasonable operative time and good recovery, without additional abdominal scarring.
authors.affiliation: Bariatric & Metabolic International Surgery Center, E-Da Hospital, Kaohsiung, Taiwan. dr.ckhuang@hotmail.com
authors.forename: Chih-Kun
authors.initials: CK
authors.lastname: Huang
authors.forename: Rajat
authors.initials: R
authors.lastname: Goel
authors.forename: Po-Chih
authors.initials: PC
authors.lastname: Chang
authors.forename: Chi-Hsien
authors.initials: CH
authors.lastname: Lo
authors.forename: Asim
authors.initials: A
authors.lastname: Shabbir
mesh_terms: D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome