title: Two hundred seventy-five single-incision laparoscopic gastric band insertions: what have we learnt?
abstract: Single-incision surgery in the morbidly obese patient has not been widely adopted, but remains a popular choice amongst patients. In the bariatric patient, it presents its own surgical challenges with hepatomegaly and increased abdominal adiposity. Here, we present our experience of 275 single-incision laparoscopic gastric bands.Between June 2009 and April 2013, 275 obese patients underwent single-incision laparoscopic adjustable gastric banding through a single incision using a multichannel single port and via a pars flaccida approach. Prospective data collection was undertaken including operating time, additional ports and additional procedures undertaken.In this series, median operative time was 60 (range 34-170) min. An additional port was placed in 15 patients (5%), including two conversions to four-port technique (0.7%). Of these patients (n = 15), the majority were male (p < 0.0001). Reasons for additional port placement included bleeding and anatomical abnormalities. Additional port placement occurred more often within the first 50 cases (5/50, 10% vs 10/225, 4%). An umbilical incision resulted in more wound-related complications than a transverse incision in the upper abdomen (p < 0.001). There were no 30-day mortality and minimal morbidity with two wound infections resulting in band removal.Single-incision laparoscopic adjustable gastric banding can be performed safely with minimal morbidity in the morbidly obese patient, and our technique has a high rate of success for all BMIs. Following 275 single-incision band insertions additional port placements were more commonly required in male patients, BMI >45 and earlier in the learning curve.
authors.affiliation: King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
authors.forename: Beth
authors.initials: B
authors.lastname: Murgatroyd
authors.forename: Saurav
authors.initials: S
authors.lastname: Chakravartty
authors.forename: Diwakar R
authors.initials: DR
authors.lastname: Sarma
authors.forename: Ameet G
authors.initials: AG
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D015391:Gastroplasty / Q000379:methods; D006529:Hepatomegaly / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D010149:Postoperative Pain; D011183:Postoperative Complications / Q000517:prevention & control / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome