St. Luke's-Roosevelt Hospital Center, Institute for Bariatric and Minimally Invasive Surgery, 1111 Amsterdam Avenue, Babcock 4W, New York, NY 10025, USA.
Surg Endosc. 2013 Apr;27(4):1287-91. doi: 10.1007/s00464-012-2597-5. Epub 2012 Dec 12.
Single-port laparoscopy (SPL) employs a 1.5- to 2.5-cm incision at the umbilicus for the placement of a single working port. We hypothesized that the longer incision created by SPL compared with multiport laparoscopy may increase the incidence of trocar-site hernias. We examined our experience with SPL in bariatric operations.
There were 734 laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding procedures performed at our institution between 2001 and 2011. Fifty-eight patients were lost to follow-up or had a short duration of follow-up (<1 month). Of the remaining 676 cases, 163 were performed via SPL. All laparoscopic wounds created by trocar size greater than 12 mm were closed with absorbable suture.
Patient demographics of the SPL group and the multiport group were similar in terms of age, gender, and comorbidities. The average body mass index (BMI) of the SPL group was lower than the multiport group (43.5 ± 5.3 vs. 45.8 ± 7.7, p < 0.01). The mean follow-up for the SPL group was 11 months versus 24 months for the multiport group. There were three trocar-site hernias out of 513 cases in the multiport compared to one hernia out of 163 cases in the SPL group (0.6 vs. 0.6 %, p = 0.967). All trocar-site hernias occurred at the 15-mm port site. The median time to hernia occurrence for the multiport group was 13 months (range, 1-18). In the SPL group, the hernia occurred at 8 months. On multivariate analysis, age, BMI, SPL, procedure type, and the postoperative weight loss were not associated with the development of trocar-site hernias.
SPL did not increase the rate of trocar-site hernia in this series. A low rate of trocar-site hernia can be achieved with the use of SPL in bariatric surgery.
单孔腹腔镜（SPL）采用脐部 1.5-2.5cm 的切口置入单一切口工作通道。我们假设与多孔腹腔镜相比，SPL 造成的更长切口可能会增加套管部位疝的发生率。我们检查了我们在减重手术中使用 SPL 的经验。
我们机构在 2001 年至 2011 年间进行了 734 例腹腔镜袖状胃切除术和腹腔镜可调胃束带术。58 例患者失访或随访时间短（<1 个月）。在剩余的 676 例患者中，有 163 例通过 SPL 进行。所有大于 12mm 套管大小的腹腔镜切口均用可吸收缝线缝合。
SPL 组和多孔组患者的人口统计学特征在年龄、性别和合并症方面相似。SPL 组的平均体重指数（BMI）低于多孔组（43.5±5.3 比 45.8±7.7，p<0.01）。SPL 组的平均随访时间为 11 个月，而多孔组为 24 个月。多孔组中有 3 例套管部位疝（513 例），SPL 组中有 1 例（163 例）（0.6%比 0.6%，p=0.967）。所有套管部位疝均发生在 15mm 套管部位。多孔组发生疝的中位时间为 13 个月（范围，1-18 个月）。在 SPL 组，疝发生在 8 个月时。多变量分析显示，年龄、BMI、SPL、手术类型和术后减重与套管部位疝的发生无关。
在本系列中，SPL 并未增加套管部位疝的发生率。在减重手术中使用 SPL 可实现低套管部位疝发生率。
