Murgatroyd Beth, Chakravartty Saurav, Sarma Diwakar R, Patel Ameet G
King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
Obes Surg. 2014 Jul;24(7):1073-7. doi: 10.1007/s11695-014-1208-z.
Single-incision surgery in the morbidly obese patient has not been widely adopted, but remains a popular choice amongst patients. In the bariatric patient, it presents its own surgical challenges with hepatomegaly and increased abdominal adiposity. Here, we present our experience of 275 single-incision laparoscopic gastric bands.Between June 2009 and April 2013, 275 obese patients underwent single-incision laparoscopic adjustable gastric banding through a single incision using a multichannel single port and via a pars flaccida approach. Prospective data collection was undertaken including operating time, additional ports and additional procedures undertaken.In this series, median operative time was 60 (range 34-170) min. An additional port was placed in 15 patients (5%), including two conversions to four-port technique (0.7%). Of these patients (n = 15), the majority were male (p < 0.0001). Reasons for additional port placement included bleeding and anatomical abnormalities. Additional port placement occurred more often within the first 50 cases (5/50, 10% vs 10/225, 4%). An umbilical incision resulted in more wound-related complications than a transverse incision in the upper abdomen (p < 0.001). There were no 30-day mortality and minimal morbidity with two wound infections resulting in band removal.Single-incision laparoscopic adjustable gastric banding can be performed safely with minimal morbidity in the morbidly obese patient, and our technique has a high rate of success for all BMIs. Following 275 single-incision band insertions additional port placements were more commonly required in male patients, BMI >45 and earlier in the learning curve.
单切口手术在病态肥胖患者中尚未得到广泛应用，但仍是患者中受欢迎的选择。对于肥胖症患者，它因肝脏肿大和腹部脂肪增多而带来自身的手术挑战。在此，我们介绍我们275例单切口腹腔镜胃束带手术的经验。2009年6月至2013年4月期间，275例肥胖患者通过使用多通道单端口并经松弛部入路，经单一切口接受了单切口腹腔镜可调节胃束带手术。进行了前瞻性数据收集，包括手术时间、额外切口和额外进行的手术。在本系列中，中位手术时间为60（范围34 - 170）分钟。15例患者（5%）放置了额外切口，包括2例转为四切口技术（0.7%）。在这些患者（n = 15）中，大多数为男性（p < 0.0001）。放置额外切口的原因包括出血和解剖异常。额外切口放置在前50例中更常见（5/50，10% 对比 10/225，4%）。脐部切口比上腹部横向切口导致更多与伤口相关的并发症（p < 0.001）。无30天死亡率，发病率极低，有两例伤口感染导致胃束带移除。单切口腹腔镜可调节胃束带手术在病态肥胖患者中可安全进行，发病率极低，并且我们的技术对所有体重指数都有很高的成功率。在275例单切口胃束带置入术后，男性患者、体重指数>45以及在学习曲线早期更常需要放置额外切口。
