Single-Incision Laparoscopic Sleeve Gastrectomy: Review and a Critical Appraisal.
BACKGROUND
Single-incision laparoscopic surgery has attracted a great deal of interest in the surgical community in recent years, including bariatric surgery. Single-incision laparoscopic sleeve gastrectomy (SILSG) has been proposed as an alternative to the multiport laparoscopic procedure; however, it has yet to meet wide acceptance and application.


OBJECTIVE
We aim to summarize existing data on SILSG and check the procedure's feasibility, technical details, safety, and, if possible, outcomes.


METHODS
We checked the most important databases for studies concerning SILSG and included all these that summarized the criteria placed and contained the data needed for this review. We excluded case reports.


RESULTS
Nineteen studies complied with the criteria of our review, containing a total of 1679 patients. Their mean age has been 38.91 years and the mean preoperative body mass index has been 41.8 kg/m2. In majority of cases (60.5%), a left upper quadrant incision has been preferred and in 97.6%, a commercially available multiport system has been picked. A wide variety of instruments have been used and mean operating time has been 94.6 minutes. One conversion to open surgery has been reported and 7.4% required the placement of additional ports. There was a complication rate of 7.38% (most common being bleeding with a rate of 2.5%) and a reoperation rate of 2.8%. Mean excess weight loss for a follow-up of 1 year was achieved in 53.7% of patients and was 70.06%. A tendency for less analgesia and better wound satisfaction has been reported.


CONCLUSIONS
SILSG is safe and feasible. However, there is insufficient evidence to recommend it as the new gold standard for sleeve gastrectomy in the place of conventional laparoscopic sleeve gastrectomy. Randomized controlled trials are needed to analyze the results and the possible benefits of this technique.
1st Department of Surgery, National Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece .
Nikolaos
N
Dimitrokallis
1st Department of Surgery, National Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece .
Andreas
A
Alexandrou
1st Department of Surgery, National Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece .
Dimitrios
D
Schizas
1st Department of Surgery, National Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece .
Anastasios
A
Angelou
1st Department of Surgery, National Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece .
Emmanouil
E
Pikoulis
1st Department of Surgery, National Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece .
Theodoros
T
Liakakos
D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D009767:Obesity, Morbid / Q000601:surgery*; D016896:Treatment Outcome; D015431:Weight Loss
SILS; SILSG; bariatric surgery; less; obesity surgery; single-incision sleeve gastrectomy