GRAPEVINE, TEX. — Performing adjustable gastric band surgery entirely through a single laparoscopic incision is both technically feasible and safe. But does it offer any clinical advantages over the conventional five-port laparoscopic technique?
The answer is unclear. And it will have to come from a prospective randomized clinical trial, Dr. Ninh T. Nguyen said at the annual meeting of the American Society for Metabolic and Bariatric Surgery.
“Going from open surgery with a midline operation to laparoscopy is a huge jump with significant clinical benefit to the patient. When we jump from laparoscopy to single incision, I think the benefit is significantly less: a possible reduction in postoperative pain—not proven—and probably improved cosmesis,” observed Dr. Nguyen of the University of California, Irvine, Medical Center.
Dr. Nguyen, who began doing adjustable gastric banding through a single 4-cm incision in the spring of 2008, presented a comparative study involving 23 patients who underwent the novel surgery and an equal number of controls who had conventional laparoscopic adjustable gastric banding (LAGB), the second most widely performed bariatric operation after gastric bypass.
The two groups in the study were matched for age, sex, and body mass index. Participants had a mean BMI of 40 kg/m
“I have a low threshold for conversion to conventional laparoscopy if visualization is technically difficult,” the surgeon explained.
Weight loss is the same in the two groups at this early point, with maximum follow-up of less than a year.
Dr. Nguyen emphasized that single-incision LAGB isn't for all patients. He won't offer it to patients with a history of any primary abdominal surgery, a hiatal hernia detected on his required preoperative upper GI study, an android body habitus, or superobesity.
The objective in single-incision gastric banding is to perform the entire operation through the standard 4-cm incision needed to place the bands in the abdomen, eliminating the other four conventional ports. It's technically demanding surgery. He considers single-incision laparoscopic appendectomy and cholecystectomy easier procedures to start with.
“You've got to get your instrumentation right. You've got to learn the hand-eye coordination. Single-site surgery is completely different from doing a conventional laparoscopic operation. There's instrument sword-fighting, and you have to find ways to avoid that,” he explained.
He also provided practical tips in getting started with single-incision LAGB for audience members who said they're under growing pressure from patients and equipment reps to offer the procedure.
He recommended starting out by taking a single-incision endoscopy course—the American Society for Metabolic and Bariatric Surgery offers an excellent one, he noted—then doing a preceptorship with a surgeon who's accomplished in the procedure, followed by a proctorship, in which an experienced surgeon visits the trainee's practice and assists in several cases.
Dr. Nguyen disclosed that he is a consultant to Covidien and Gore & Associates Inc.
Exclude patients with primary abdominal surgery, a hiatal hernia, an android body habitus, or superobesity.
Source DR. NGUYEN