Kang So Hyun, Park Young Suk, Ahn Sang-Hoon, Park Do Joong, Kim Hyung-Ho
Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
J Obes Metab Syndr. 2018 Mar 30;27(1):25-34. doi: 10.7570/jomes.2018.27.1.25.
Bariatric surgery is an established and effective treatment, not only to combat morbid obesity, but also to address associated metabolic comorbidities. At this time, the cutoff for bariatric or metabolic surgery in terms of body mass index (BMI) is decreasing, making it more feasible for certain individuals to consider minimally invasive surgical options. Innovations in the technique have led to the application of laparoendoscopic single-site surgery (LESS) in the field of bariatrics, which uses a single or no incision in the performance of weight-reducing surgery. To date, there is no consensus regarding patient selection though most candidates for single-port bariatric surgery are female. Some doctors suggest that single-port bariatric surgery may not be recommended in patients with BMI of more than 50 kg/m, height of more than 180 cm, and xiphoid-umbilicus distance of more than 20 cm. Sleeve gastrectomy (SG) is now the most widely performed bariatric surgery worldwide and single-port SG (SPSG) is already established as a routine procedure in various institutions. Current evidence shows that SPSG is less painful and demonstrates higher rates of patient satisfaction regarding the wound. SPSG is feasible and is recommendable in patients who meet certain criteria. Furthermore, endoscopic treatment modalities such as intragastric balloons and endoluminal malabsorptive devices are being developed to bridge the gap between medical and surgical treatments. Nevertheless, there is still insufficient evidence to prove the superiority of LESS bariatric surgery over conventional laparoscopic surgery. Large, well-designed prospective analyses are needed to determine the criteria for selecting patients suitable to undergo LESS bariatric surgery and to predict the procedure's role in the growth of bariatric surgery.
减重手术是一种成熟且有效的治疗方法，不仅可用于对抗病态肥胖，还能解决相关的代谢合并症。目前，减重或代谢手术在体重指数（BMI）方面的阈值正在降低，这使得某些个体考虑微创外科手术选择变得更加可行。技术创新已促使腹腔镜单孔手术（LESS）在减重领域得到应用，该手术在进行减重手术时采用单一切口或无切口。迄今为止，关于患者选择尚无共识，不过大多数单孔减重手术的候选者为女性。一些医生建议，BMI超过50kg/m²、身高超过180cm且剑突至脐距离超过20cm的患者可能不建议进行单孔减重手术。袖状胃切除术（SG）目前是全球开展最广泛的减重手术，单孔袖状胃切除术（SPSG）已在各机构确立为常规手术。现有证据表明，SPSG的疼痛较轻，患者对伤口的满意度更高。SPSG是可行的，对于符合特定标准的患者是可推荐的。此外，诸如胃内球囊和腔内吸收不良装置等内镜治疗方式正在研发中，以弥合药物治疗和手术治疗之间的差距。然而，仍缺乏足够证据证明LESS减重手术优于传统腹腔镜手术。需要进行大规模、设计良好的前瞻性分析，以确定适合接受LESS减重手术的患者选择标准，并预测该手术在减重手术发展中的作用。
