title: Transumbilical sleeve gastrectomy with an accessory lateral port: surgical results in 237 patients and 1-year follow-up.
abstract: BACKGROUND
  The transumbilical approach has recently been shown to be safe for several surgical procedures. Case series of sleeve gastrectomy (SG) with a transumbilical approach (TUSG) has been reported with various techniques. The objective of this report is to present the technique, surgical results, and 1-year follow-up results of simplified TUSG using rigid instruments.
  
  
  METHODS
  All of the patients who had undergone SG since July 2010 were offered a transumbilical approach. The operative technique involves a transumbilical incision and the introduction of a SILS® or GelPoint® multiport and a 5-mm metallic accessory trocar laterally in the left flank. Rigid instruments were used in all patients. Gastric transection was made 4-5 cm proximal to the pylorus, calibrated with a 36-Fr bougie. Selected hemostasis to the staple line was achieved with metallic clips.
  
  
  RESULTS
  A total of 237 patients underwent TUSG. Patient body mass index ranged from 30 to 46 kg/m(2). The mean operative time was 49.5 ± 14.9 min. Six patients presented with early complications, including hemoperitoneum in three cases, antral leak in one case, intestinal perforation in one case, and portal vein thrombosis in one case. Conversion to the multitrocar technique was required in one patient. There were no mortalities. The mean length of hospital stay was 2.2 ± 1 days. The cosmetic result was satisfactory for all of the patients.
  
  
  CONCLUSIONS
  TUSG is a safe and feasible procedure using the described technique. The insertion of a 5-mm assistance trocar simplifies the procedure, allowing the use of rigid instruments.
authors.affiliation: Centro Integral de Nutrición y Obesidad, Clínica Tabancura, Santiago de Chile, 7650018, Chile.
authors.forename: Carlos
authors.initials: C
authors.lastname: Farías
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Fernández
authors.forename: Cristián
authors.initials: C
authors.lastname: Ovalle
authors.forename: Carolina
authors.initials: C
authors.lastname: Cabrera
authors.forename: Jaime
authors.initials: J
authors.lastname: de la Maza
authors.forename: Karin
authors.initials: K
authors.lastname: Kosiel
authors.forename: Ana María
authors.initials: AM
authors.lastname: Molina
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000453:epidemiology / Q000601:surgery*; D015992:Body Mass Index; D002677:Chile / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D061646:Operative Time; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000601:surgery*; D011708:Pylorus / Q000601:surgery; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery*; D015431:Weight Loss