SILC is superior to MLC in terms of cosmetic outcome, but not in postoperative pain and requirement for analgesics.

BackgroundLaparoscopic Roux-en-Y gastric bypass (LRYGB) can dramatically ameliorate type 2 diabetes mellitus (T2DM) in morbidly obese patients. However, there is little evidence supporting the effectiveness of LRYGB in low body mass index (BMI) patients. The study was designed to evaluate the safety and results of LRYGB for achieving T2DM remission in patients with BMI in the range of 25–35 kg/m2.MethodsTwenty-two patients (two men and 20 women) with T2DM underwent LRYGB. Data on patient demographics, BMI, co-morbidities, and details of diabetes mellitus, including disease duration, family history, medication use, and remission, were prospectively collected and analyzed.ResultsThe mean age was 47 years (range, 28–63 years), mean BMI was 30.81 (range, 25.00–34.80 kg/m2), and mean duration of T2DM onset was 6.57 years (range, 1–20 years). Sixteen (72.27%) patients had a family history of T2DM. There was no mortality, but two (9%) patients experienced complications: an early gastrojejunostomy hemorrhage and frequent loose stools that required revision surgery. At 12 months, 14 (63.6%) patients showed T2DM remission, six (27.3%) showed glycemic control, and two (9.1%) showed improvement. The group achieving remission had a higher BMI (p = 0.001), younger age (p = 0.002), and shorter duration of diabetes (p = 0.001). These three factors may be predictors of diabetes resolution at 12 months.ConclusionEarly intervention in low-BMI patients yields better remission rates because age, BMI, and duration of T2DM predict glycemic outcomes.

BackgroundRecently, single-incision laparoscopic surgery (SILS) has been used for bariatric procedures, and this surgery is considered a type of minimally invasive surgery. When SILS is performed via the transumbilical route, the resultant abdominal wound is hidden and the cosmetic outcome is better. However, because of the small angle of manipulation and difficulty in liver traction, this technique is not used to perform complex bariatric surgery. In this prospective study, we used our novel technique, which involves the use of a liver-suspension tape and umbilicoplasty of an omega-shaped incision (omega umbilicoplasty), to perform laparoscopic bariatric surgery via the single-incision transumbilical (SITU) approach. We then assessed the safety and effectiveness of our surgical technique.MethodsWe started performing and developing this technique from December 2008. Until July 2009, 40 consecutive patients underwent 40 bariatric procedures: two adjustable gastric band placements, six sleeve gastrectomies, and 32 Roux-en-Y gastric bypass operations, including five cases where concomitant cholecystectomy was performed.ResultsThe mean operation time was 93.4 min and the mean duration of postoperative hospitalization was 1.15 days. No perioperative or postoperative complications or deaths occurred. Most patients were very satisfied with the cosmetic outcomes.ConclusionOur technique can be safely and effectively used for SITU laparoscopic bariatric surgery. This technique will soon be used for advanced abdominal surgeries besides bariatric ones.

During bariatric surgery in morbidly obese patients, the surgeon's operative view is often obscured by the hypertrophic fatty left lobe of the liver. The use of a conventional liver retractor mandates an additional subxiphoid wound, resulting in pain and scar formation, in addition to the risk of iatrogenic liver injury during retractor insertion. To overcome these limitations, we developed a simple, rapid, and safe technique for liver retraction--V-shaped liver suspension technique (V-LIST)--by using a Penrose drain and laparoscopic stapler. A silicone Penrose drain was inserted into the peritoneal cavity and stapled to the pars condensa of the lesser omentum and parietal peritoneum using a laparoscopic stapler. The left lobe of the liver was retracted by the V-shaped suspension. At the end of the surgery, the drain could be easily removed. In October 2009-February 2010, 14 patients underwent liver retraction with the use of this technique. We performed 12 Roux-en-Y gastric bypasses and 2 sleeve gastrectomies. This series also included three cases of single incision transumbilical laparoscopic surgery. The mean time required to complete the liver retraction was 8 min 21 s (range, 2-18 min 40 s). Retraction was appropriate in all patients, without the need for additional retractors or conversion. There were no V-LIST-related perioperative complications. Our V-LIST technique using a Penrose drain is safe and simple. It has potential applications in single incision laparoscopic bariatric procedures.

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