[Three-port laparoscopic sleeve gastrectomy: feasibility and short outcomes in 25 consecutives super-obese patients]

Abstract

Introduction: The aim of this paper is to propose our technique, namely three-port laparoscopic sleeve gastrectomy (TPLSG), to define the feasibility and expose the short-outcomes, as an alternative between the standard laparoscopic approach and the single incision (SILSG) for such patients.

Material and methods: We conducted a prospective study of 25 patients: 12 male and 13 female, reporting a mean BMI of 53 kg/m² (range: 50-72) and a mean age of 38 years (range: 29-55). To evaluate the feasibility of our technique we have always respecting 3 pre-operatives conditions: BMI ≥ 50 kg/m². Preoperative abdominal US or CT to measure the liver and determine the hepato-splenic characteristics. "Intent to treat by 3 ports" (2 of 5 mm and one 12 mm in diameter). The short outcomes follow-up include: operative time, conversion, transfusions, fistula, reinterventions and parietal herniation at one and three months after surgery.

Results: Hepatomegaly was present in 19 (76%) patients, and it's greater on the left hepatic lobe in 9 (36%) patients. The mean operation time was 72 min (range: 50-110). No per-operative complications were observed. Conversion to four ports procedure was necessary in one patient. The mean hospital stay was 3 days (range: 2-5). No mortality and 30th POD morbidity rate was reported. No patient developed an incisional hernia to date.

Conclusion: The TPLSG reduces the ports in number and in size and subsequently the parietal trauma, it also an instrumental triangulation, making surgery safe and reproducible.