Single-incision and dual-incision laparoscopic adjustable gastric band: Evaluation of initial experience

Carlos A Galvani, Alberto S. Gallo, Maria V. Gorodner

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background The laparoscopic adjustable gastric band (LAGB) technique has been well described. Most surgeons have used a 4-trocar technique, with an additional incision for a liver retractor. Single incision (SI)-LAGB seeks to further decrease the invasiveness of the procedure. The purpose of the present report was to evaluate the safety and feasibility of SI-LAGB and the effect on the learning curve. Methods All cases performed from October 2008 to October 2009 were reviewed. Both true SI and dual-incision LAGB cases were included. The cases were performed through either a left paramedian or a transumbilical incision. The liver was retracted using the Nathanson retractor or an intracorporeal retractor. Results Of the 89 patients studied, 89% were women. Their mean age was 41 ± 12 years (range 1974), and their body mass index was 46 ± 12 kg/m 2 (range 3263). The first 27 patients underwent dual-incision LAGB using the Nathanson retractor. The operative time was 45 ± 12 minutes (range 2190). After the first 35 cases, a reduction in the operative time was observed (P =.03). Simultaneous hiatal hernia repair added an average of 11 minutes of operative time for 40 patients (45%). The conversion rate was 26% for the first 35 cases, 5% for the second 35 cases, and 0% for the last 19 cases. Conversion was represented by adding a 5-mm trocar or the Nathanson retractor. The length of stay was 7 ± 9 hours (range 236), and 81 patients (91%) qualified for outpatient surgery. The complications included 1 seroma, 1 reoperation because of band obstruction, and 1 case of esophageal dysmotility after surgery. Conclusion The results of our study have shown that SI-LAGB is a viable alternative to traditional LAGB and can be considered reliable, with low morbidity. The learning curve for consistent completion of SI-LAGB in our experience appeared to be the first 35 cases. We advise standardizing the procedure to facilitate the reproducibility of this technique.

Original languageEnglish (US)
Pages (from-to)194-200
Number of pages7
JournalSurgery for Obesity and Related Diseases
Volume8
Issue number2
DOIs
StatePublished - Mar 2012

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Stomach
Operative Time
Learning Curve
Surgical Instruments
Esophageal Motility Disorders
Seroma
Hiatal Hernia
Herniorrhaphy
Liver
Ambulatory Surgical Procedures
Reoperation
Length of Stay
Body Mass Index
Morbidity
Safety

ASJC Scopus subject areas

  • Surgery

Cite this

Single-incision and dual-incision laparoscopic adjustable gastric band : Evaluation of initial experience. / Galvani, Carlos A; Gallo, Alberto S.; Gorodner, Maria V.

In: Surgery for Obesity and Related Diseases, Vol. 8, No. 2, 03.2012, p. 194-200.

Research output: Contribution to journalArticle

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title = "Single-incision and dual-incision laparoscopic adjustable gastric band: Evaluation of initial experience",
abstract = "Background The laparoscopic adjustable gastric band (LAGB) technique has been well described. Most surgeons have used a 4-trocar technique, with an additional incision for a liver retractor. Single incision (SI)-LAGB seeks to further decrease the invasiveness of the procedure. The purpose of the present report was to evaluate the safety and feasibility of SI-LAGB and the effect on the learning curve. Methods All cases performed from October 2008 to October 2009 were reviewed. Both true SI and dual-incision LAGB cases were included. The cases were performed through either a left paramedian or a transumbilical incision. The liver was retracted using the Nathanson retractor or an intracorporeal retractor. Results Of the 89 patients studied, 89{\%} were women. Their mean age was 41 ± 12 years (range 1974), and their body mass index was 46 ± 12 kg/m 2 (range 3263). The first 27 patients underwent dual-incision LAGB using the Nathanson retractor. The operative time was 45 ± 12 minutes (range 2190). After the first 35 cases, a reduction in the operative time was observed (P =.03). Simultaneous hiatal hernia repair added an average of 11 minutes of operative time for 40 patients (45{\%}). The conversion rate was 26{\%} for the first 35 cases, 5{\%} for the second 35 cases, and 0{\%} for the last 19 cases. Conversion was represented by adding a 5-mm trocar or the Nathanson retractor. The length of stay was 7 ± 9 hours (range 236), and 81 patients (91{\%}) qualified for outpatient surgery. The complications included 1 seroma, 1 reoperation because of band obstruction, and 1 case of esophageal dysmotility after surgery. Conclusion The results of our study have shown that SI-LAGB is a viable alternative to traditional LAGB and can be considered reliable, with low morbidity. The learning curve for consistent completion of SI-LAGB in our experience appeared to be the first 35 cases. We advise standardizing the procedure to facilitate the reproducibility of this technique.",
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AB - Background The laparoscopic adjustable gastric band (LAGB) technique has been well described. Most surgeons have used a 4-trocar technique, with an additional incision for a liver retractor. Single incision (SI)-LAGB seeks to further decrease the invasiveness of the procedure. The purpose of the present report was to evaluate the safety and feasibility of SI-LAGB and the effect on the learning curve. Methods All cases performed from October 2008 to October 2009 were reviewed. Both true SI and dual-incision LAGB cases were included. The cases were performed through either a left paramedian or a transumbilical incision. The liver was retracted using the Nathanson retractor or an intracorporeal retractor. Results Of the 89 patients studied, 89% were women. Their mean age was 41 ± 12 years (range 1974), and their body mass index was 46 ± 12 kg/m 2 (range 3263). The first 27 patients underwent dual-incision LAGB using the Nathanson retractor. The operative time was 45 ± 12 minutes (range 2190). After the first 35 cases, a reduction in the operative time was observed (P =.03). Simultaneous hiatal hernia repair added an average of 11 minutes of operative time for 40 patients (45%). The conversion rate was 26% for the first 35 cases, 5% for the second 35 cases, and 0% for the last 19 cases. Conversion was represented by adding a 5-mm trocar or the Nathanson retractor. The length of stay was 7 ± 9 hours (range 236), and 81 patients (91%) qualified for outpatient surgery. The complications included 1 seroma, 1 reoperation because of band obstruction, and 1 case of esophageal dysmotility after surgery. Conclusion The results of our study have shown that SI-LAGB is a viable alternative to traditional LAGB and can be considered reliable, with low morbidity. The learning curve for consistent completion of SI-LAGB in our experience appeared to be the first 35 cases. We advise standardizing the procedure to facilitate the reproducibility of this technique.

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