Department of Surgery, King's College Hospital, National Health Services Foundation Trust, London, United Kingdom.
Surg Obes Relat Dis. 2012 Nov-Dec;8(6):747-51. doi: 10.1016/j.soard.2011.06.013. Epub 2011 Jul 13.
As single incision surgery increases in popularity, the feasibility of offering this approach in bariatric surgery is further progression of this surgical technique. With the technical challenges that both operating on the morbidly obese patient and single incision surgery present, we describe our initial experience undertaking 111 single-incision gastric band insertions.
From June 2009 to October 2010, 111 obese patients underwent single-incision laparoscopic adjustable gastric banding through a single transverse incision using a multichannel single port and a pars flaccida technique. Prospective data collection was undertaken, including visual analog scores.
In this initial series, the median operative time was 65 minutes (range 34-165). There was 1 conversion to a 5-port laparoscopic technique (.9%), and an additional port was placed in 7 patients (6%). Male patients were more likely to require an additional port (P < .05). The single-incision size ranged from 26 to 45 mm (median 35). At 23 hours postoperatively, the median pain score was 2.5 on a 0-10 visual analog score. On multivariate analysis, pain was found to increase with operation time (P < .001). The median length of stay was 24 hours (range 5.5-48). There was no mortality and minimal morbidity, with 1 wound infection necessitating band removal.
Single-incision laparoscopic adjustable gastric banding can be performed safely with minimal morbidity and mortality in the morbidly obese patient, and our technique has a high rate of success. The benefits compared with the traditional laparoscopic approach and long-term outcomes are yet to be established. However, if the intra-abdominal operative time is >60 minutes, one should consider the placement of an additional port, especially in male patients.
随着单切口手术越来越受欢迎，将这种方法应用于减重手术是该手术技术的进一步发展。由于病态肥胖患者的手术和单切口手术都存在技术挑战，我们描述了我们进行 111 例单切口胃带插入术的初步经验。
从 2009 年 6 月至 2010 年 10 月，111 例肥胖患者通过单个横向切口使用多通道单端口和膜性软组织结构技术进行单切口腹腔镜可调胃带。进行了前瞻性数据收集，包括视觉模拟评分。
在这个初步系列中，中位手术时间为 65 分钟（范围 34-165 分钟）。有 1 例（0.9%）转换为 5 端口腹腔镜技术，另有 7 例（6%）放置了附加端口。男性患者更有可能需要附加端口（P <.05）。单切口大小范围为 26-45 毫米（中位数 35 毫米）。术后 23 小时，中位数疼痛评分为 0-10 视觉模拟评分的 2.5。在多变量分析中，发现疼痛随手术时间的增加而增加（P <.001）。中位住院时间为 24 小时（范围 5.5-48 小时）。无死亡病例，发病率低，仅 1 例伤口感染需要去除带。
在病态肥胖患者中，单切口腹腔镜可调胃带可以安全进行，发病率和死亡率低，我们的技术成功率高。与传统腹腔镜方法相比的优势和长期结果尚待确定。然而，如果腹腔内手术时间>60 分钟，应考虑放置附加端口，尤其是在男性患者中。
