St. Luke's-Roosevelt Hospital Center, University Hospital of Columbia University College of Physicians and Surgeons, New York, New York.
Surg Obes Relat Dis. 2013 Sep-Oct;9(5):686-91. doi: 10.1016/j.soard.2012.11.009. Epub 2013 Jan 17.
Laparoendoscopic single-site (LESS) surgery has been shown to be a well-tolerated alternative for the placement of an adjustable gastric band. To date, only small series have suggested that this approach may provide potential clinical benefits over standard multiport laparoscopy. The objective of this study was to compare the outcomes of patients undergoing LESS adjustable gastric banding (LESS-AGB) and a cohort of patients undergoing standard multiport laparoscopic adjustable gastric banding (LAGB).
A total of 206 patients underwent placement of an adjustable gastric band. Of these, 106 patients underwent LESS-AGB and were compared with a demographically similar cohort of 100 patients who underwent standard LAGB. Data collected included operative time, parenteral and oral narcotic consumption, duration of patient controlled analgesia (PCA) device, subjective pain scores using the 0-10 numeric pain intensity scale, and length of stay. Unpaired t test was used for analysis.
Compared with multiport LAGB patients, LESS-AGB patients reported significantly less pain at the first postoperative hour (P = .012), twelfth postoperative hour (P = .017), and twenty-fourth postoperative hour (P = .012), and consumed fewer oral analgesic tablets (P = .012). Operative times were significantly longer in the LESS-AGB group (P = .029). No significant differences were seen in duration of PCA, parenteral narcotic consumption, or length of stay. One LESS-AGB case required conversion to multiport laparoscopy. Complication rates were similar between the 2 groups.
LESS-AGB is associated with less pain and less oral analgesic consumption than multiport LAGB. Given these clinical advantages and superior cosmetic results, laparoendoscopic single-site surgery may be an attractive alternative approach for patients considering LAGB.
腹腔镜单部位（LESS）手术已被证明是一种可耐受的替代方法，可用于放置可调节胃束带。迄今为止，只有小系列研究表明，这种方法可能比标准多孔腹腔镜具有潜在的临床益处。本研究的目的是比较接受腹腔镜单部位可调胃束带术（LESS-AGB）和一组接受标准多孔腹腔镜可调胃束带术（LAGB）的患者的结局。
共有 206 例患者接受了可调胃束带的放置。其中，106 例患者接受了 LESS-AGB，并与 100 例接受标准 LAGB 的相似人群进行了比较。收集的数据包括手术时间、静脉和口服麻醉药物的使用、患者自控镇痛（PCA）装置的使用时间、使用 0-10 数字疼痛强度量表的主观疼痛评分以及住院时间。采用未配对 t 检验进行分析。
与多孔 LAGB 患者相比，LESS-AGB 患者在术后第 1 小时（P =.012）、第 12 小时（P =.017）和第 24 小时（P =.012）时疼痛明显减轻，口服止痛药片数也明显减少（P =.012）。LESS-AGB 组的手术时间明显延长（P =.029）。PCA 持续时间、静脉麻醉药物使用量和住院时间无显著差异。1 例 LESS-AGB 患者需要转为多孔腹腔镜。两组的并发症发生率相似。
与多孔 LAGB 相比，LESS-AGB 术后疼痛较轻，口服止痛药用量较少。鉴于这些临床优势和更好的美容效果，腹腔镜单部位手术可能是考虑接受 LAGB 的患者的一种有吸引力的替代方法。
