title: Laparoscopic bariatric surgery can be performed through a single incision: a comparative study.
abstract: BACKGROUND
  The application of single-incision laparoscopic surgery (SILS) in bariatric patients has been limited to less complex procedures. We evaluated the short-term outcomes of SILS sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), compared to a group of well-established minimally invasive techniques.
  
  
  METHODS
  Twenty-eight morbidly obese patients who underwent SILS SG (n = 14) and RYGB (n = 14) were compared to a matched control group composed of 28 cases of conventional laparoscopic surgery (CLS). A single vertical 2.5-3-cm intra-umbilical incision, three-ports placed trans-fascially, and a liver suspension technique were used to perform SILS.
  
  
  RESULTS
  Both groups were comparable in terms of age (p = 0.96), gender (p = 1.0), type of procedure (p = 1.0), and number of comorbidities (p = 0.63). Two (7%) SILS patients required placement of one additional port, and no conversions to CLS or open surgery were needed. The estimated blood loss (p = 0.48), operative time (p = 0.33), length of hospital stay (p = 0.79), overall 90-day perioperative complication rate (p = 1.0), and short-term weight loss (p = 0.53) were comparable between the two groups. In terms of pain control, the frequency of patient-controlled analgesia use in both groups was similar. However, the pain score (assessed by visual analog scale) was significantly less for SILS patients on postoperative days 1 (5.0 ± 2.1 vs. 6.5 ± 1.8; p = 0.007) and 2 (4.0 ± 2.0 vs. 5.1 ± 2.4; p = 0.49). Cosmetic satisfaction with the scar was high in the SILS group. No patients required reoperation or readmission during the 90 days after surgery.
  
  
  CONCLUSIONS
  SILS is feasible in carefully selected bariatric patients and results in short-term outcomes comparable to those observed after CLS. Improved pain and cosmesis are potential benefits of SILS.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Ave, M66-06, Cleveland, OH, 44118, USA, rogulat@ccf.org.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rogula
authors.forename: Christopher
authors.initials: C
authors.lastname: Daigle
authors.forename: Monica
authors.initials: M
authors.lastname: Dua
authors.forename: Hideharu
authors.initials: H
authors.lastname: Shimizu
authors.forename: Jonathan
authors.initials: J
authors.lastname: Davis
authors.forename: Olga
authors.initials: O
authors.lastname: Lavryk
authors.forename: Ali
authors.initials: A
authors.lastname: Aminian
authors.forename: Philip
authors.initials: P
authors.lastname: Schauer
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled; D002921:Cicatrix; D004954:Esthetics; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D015431:Weight Loss