Weight-loss outcomes of SPIDER(®) sleeve gastrectomy at 6 months compared to traditional laparoscopic technique.
BACKGROUND
Laparoscopic sleeve gastrectomy (LSG) has become a primary stand-alone procedure for weight-loss surgery. The standard technique for LSG involves several small abdominal incisions. The single port instrument delivery extended reach (SPIDER(®)) surgical system has been introduced as a single site modality. This technique has been described previously; however, weight-loss outcomes of SPIDER(®) sleeve gastrectomy have not been compared to multi-port LSG.


METHODS
We performed a retrospective review of a prospectively collected database. All cases were performed by a single surgeon between August 2011 and September 2013. Thirty-two patients underwent SPIDER(®) sleeve gastrectomy, while 30 underwent LSG. Primary outcomes were change in BMI and percent excess weight loss (%EWL) at 6 months post-operatively. Secondary outcomes included: operative time, estimated blood loss (EBL), and complications.


RESULTS
There were no demographic differences between cohorts except initial BMI (SPIDER(®) = 42.1, LSG = 46.5, p < 0.001). Mean %EWL at 6 months post-operatively was higher in the SPIDER(®) cohort (59.1 vs. 48.3 %, p < 0.005). Similarly there was a lower mean BMI at 6 months post-operatively in the SPIDER(®) cohort (31.1 vs. 35.5, p < 0.0001). The net change in BMI for each cohort was equivalent (SPIDER(®) = 11.1, LSG = 11.0, p = 0.95). Mean operative time was longer in SPIDER(®) cases (104.6 vs. 90.7 min, p < 0.02), while EBL was equivalent (32.1 vs. 34.3 mL, p = 0.56). There was one post-operative hemorrhage requiring laparoscopic clot evacuation in the SPIDER(®) cohort, and one wound infection in the LSG cohort.


CONCLUSIONS
SPIDER(®) sleeve gastrectomy is not inferior to LSG with regard to decrease in BMI and %EWL at 6-months post-operatively. The higher %EWL observed in the SPIDER(®) cohort is likely due to patient selection bias. This study demonstrates that the SPIDER(®) technique is a viable alternative to LSG with similar weight-loss outcomes.
Department of Surgery, William Beaumont Army Medical Center, 5005 N. Piedras, ATTN: DOS, El Paso, TX, 79920, USA. kathryn.b.muir.mil@mail.mil.
Kathryn B
KB
Muir
Department of Surgery, William Beaumont Army Medical Center, 5005 N. Piedras, ATTN: DOS, El Paso, TX, 79920, USA.
William V
WV
Rice
D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D016208:Databases, Factual; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
Bariatric surgery; SPIDER®; Single-site surgery; Sleeve gastrectomy