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Published in: Obesity Surgery 12/2017

01-12-2017 | How I Do It

Bikini Line Sleeve Gastrectomy: Initial Report

Author: Tamer N. Abdelbaki

Published in: Obesity Surgery | Issue 12/2017

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Abstract

Background/introduction

Several reports have discussed the potential for reducing port access in laparoscopic sleeve gastrectomy (LSG); however, each approach had its innate setbacks. Aiming at improving the aesthetic outcome, we report a novel approach to the LSG where we place the trocars at the bikini line in what we described as bikini line sleeve gastrectomy (BLSG).

Methods

The present work is a prospective, pilot study on the use of BLSG in patients, during the period between April and October 2016. Exclusion criteria included the following: large hiatal hernia, upper abdominal surgery, and xiphi-umbilical, xiphi-symphysis pubis, and xiphi-anterior superior iliac spine distances of > 25,36 and 33 cm, respectively. Four trocars were used: one at the umbilicus and three at the bikini line. All laparoscopic graspers were bariatric length instruments (43 cm). However, camera telescope, endoscopic stapler, and bipolar dissectors were standard length.

Results

Twenty eight patients underwent BLSG. The mean age was 34.6 ± 3.7 years with a mean BMI of 42.46 kg/m2 ± 3. There were no major intra- or postoperative complications and no conversion to conventional port site placement. Patient’s scar satisfaction was favorable. The mean postoperative BMI and weight at 6 m were 28.5 ± 1 kg/m2 and 79.8 kg ± 2, respectively. The mean percentage excess weight loss at 3, 6, and 12 months were 39.5 ± 4.6, 64.5 ± 5, and 69.8 ± 6%, respectively.

Conclusion

BLSG was found to be potentially safe, feasible, and effective with a favorable aesthetic outcome; it could possibly be offered to a select group of patients that are conscious about their scar appearance.
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Literature
1.
go back to reference Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefPubMed Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefPubMed
3.
go back to reference Stefanopoulos A, Economopoulos KP, Kalles V. Single incision laparoscopic sleeve gastrectomy: a review. Obes Surg. 2015;25(8):1502–10.CrossRefPubMed Stefanopoulos A, Economopoulos KP, Kalles V. Single incision laparoscopic sleeve gastrectomy: a review. Obes Surg. 2015;25(8):1502–10.CrossRefPubMed
4.
go back to reference Dunford G, Philip S, Kole K. Three-port laparoscopic sleeve gastrectomy: a novel technical modification. Surg Laparosc Endosc Percutan Tech. 2016;26(6):174–7.CrossRef Dunford G, Philip S, Kole K. Three-port laparoscopic sleeve gastrectomy: a novel technical modification. Surg Laparosc Endosc Percutan Tech. 2016;26(6):174–7.CrossRef
5.
go back to reference Chekan E, Moore M, Hunter TD, et al. Costs and clinical outcomes of conventional single port and micro-laparoscopic cholecystectomy. JSLS. 2013;17(1):30–45.CrossRefPubMedPubMedCentral Chekan E, Moore M, Hunter TD, et al. Costs and clinical outcomes of conventional single port and micro-laparoscopic cholecystectomy. JSLS. 2013;17(1):30–45.CrossRefPubMedPubMedCentral
6.
go back to reference Henriksen NA, Al-Tayar H, Rosenberg J, et al. Cost assessment of instruments for single-incision laparoscopic cholecystectomy. JSLS. 2012;16(3):353–9.CrossRefPubMedPubMedCentral Henriksen NA, Al-Tayar H, Rosenberg J, et al. Cost assessment of instruments for single-incision laparoscopic cholecystectomy. JSLS. 2012;16(3):353–9.CrossRefPubMedPubMedCentral
7.
go back to reference Alptekin H, Yilmaz H, Acar F, et al. Incisional hernia rate may increase after single-port cholecystectomy. J Laparoendosc Adv Surg Tech A. 2012;22(8):731–7.CrossRefPubMed Alptekin H, Yilmaz H, Acar F, et al. Incisional hernia rate may increase after single-port cholecystectomy. J Laparoendosc Adv Surg Tech A. 2012;22(8):731–7.CrossRefPubMed
8.
go back to reference Durani P, McGrouther DA, Ferguson MW. The patient scar assessment questionnaire: a reliable and valid patient-reported outcomes measure for linear scars. Plast Reconstr Surg. 2009;123:1481–9.CrossRefPubMed Durani P, McGrouther DA, Ferguson MW. The patient scar assessment questionnaire: a reliable and valid patient-reported outcomes measure for linear scars. Plast Reconstr Surg. 2009;123:1481–9.CrossRefPubMed
9.
go back to reference Roa PE, Kaidar-Person O, Pinto D, et al. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006;16(10):1323–6.CrossRefPubMed Roa PE, Kaidar-Person O, Pinto D, et al. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006;16(10):1323–6.CrossRefPubMed
10.
go back to reference Deitel M, Crosby RD, Gagner M. The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, October 25-27, 2007. Obes Surg. 2008;18(5):487–96.CrossRefPubMed Deitel M, Crosby RD, Gagner M. The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, October 25-27, 2007. Obes Surg. 2008;18(5):487–96.CrossRefPubMed
11.
go back to reference Hanna GB, Cuschieri A. Influence of the optical axis-to-target view angle on endoscopic task performance. Surg Endosc. 1999;13(4):371–5.CrossRefPubMed Hanna GB, Cuschieri A. Influence of the optical axis-to-target view angle on endoscopic task performance. Surg Endosc. 1999;13(4):371–5.CrossRefPubMed
12.
go back to reference Cottam D, Qureshi FD, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20:859–63.CrossRefPubMed Cottam D, Qureshi FD, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20:859–63.CrossRefPubMed
13.
go back to reference Regan JP, Inabnet WB, Gagner M, et al. Early experience with two-stage laparoscopic roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13:861–4.CrossRefPubMed Regan JP, Inabnet WB, Gagner M, et al. Early experience with two-stage laparoscopic roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13:861–4.CrossRefPubMed
14.
go back to reference Sammour T, Hill AG, Singh P, et al. Laparoscopic sleeve gastrectomy as a single-stage bariatric procedure. Obes Surg. 2010;20:271–5.CrossRefPubMed Sammour T, Hill AG, Singh P, et al. Laparoscopic sleeve gastrectomy as a single-stage bariatric procedure. Obes Surg. 2010;20:271–5.CrossRefPubMed
15.
go back to reference Boza C, Salinas J, Salgado N, et al. Laparoscopic sleeve gastrectomy as a stand-alone procedure for morbid obesity: report of 1,000 cases and 3-year follow-up. Obes Surg. 2012;22:866–71.CrossRefPubMed Boza C, Salinas J, Salgado N, et al. Laparoscopic sleeve gastrectomy as a stand-alone procedure for morbid obesity: report of 1,000 cases and 3-year follow-up. Obes Surg. 2012;22:866–71.CrossRefPubMed
17.
go back to reference Lee SC, Choi BJ, Kim SJ. Two-port cholecystectomy maintains safety and feasibility in benign gallbladder diseases: a comparative study. Int J Surg. 2014;12(9):1014–9.CrossRefPubMed Lee SC, Choi BJ, Kim SJ. Two-port cholecystectomy maintains safety and feasibility in benign gallbladder diseases: a comparative study. Int J Surg. 2014;12(9):1014–9.CrossRefPubMed
18.
go back to reference Gaillard M, Tranchart H, Lainas P, et al. Single-port laparoscopic sleeve gastrectomy as a routine procedure in1000 patients. Surg Obes Relat Dis. 2016;12:1270–7.CrossRefPubMed Gaillard M, Tranchart H, Lainas P, et al. Single-port laparoscopic sleeve gastrectomy as a routine procedure in1000 patients. Surg Obes Relat Dis. 2016;12:1270–7.CrossRefPubMed
19.
go back to reference Saber AA, El-Ghazaly TH, Dewoolkar AV, et al. Single-incision laparoscopic sleeve gastrectomy versus conventional multiport laparoscopic sleeve gastrectomy: technical considerations and strategic modifications. Surg Obes Relat Dis. 2010;6(6):658–64.CrossRefPubMed Saber AA, El-Ghazaly TH, Dewoolkar AV, et al. Single-incision laparoscopic sleeve gastrectomy versus conventional multiport laparoscopic sleeve gastrectomy: technical considerations and strategic modifications. Surg Obes Relat Dis. 2010;6(6):658–64.CrossRefPubMed
20.
go back to reference Saber AA, El-Ghazaly TH, Elian A, et al. Single-incision laparoscopic placement of adjustable gastric band versus conventional multiport laparoscopic gastric banding: a comparative study. Am Surg. 2010;76(12):1328–32.PubMed Saber AA, El-Ghazaly TH, Elian A, et al. Single-incision laparoscopic placement of adjustable gastric band versus conventional multiport laparoscopic gastric banding: a comparative study. Am Surg. 2010;76(12):1328–32.PubMed
21.
go back to reference Ruiz-Tovar J, Muñoz JL, Gonzalez J, et al. Postoperative pain after laparoscopic sleeve gastrectomy: comparison of three analgesic schemes (isolated intravenous analgesia, epidural analgesia associated with intravenous analgesia and port-sites infiltration with bupivacaine associated with intravenous analgesia). Surg Endosc. 2017;31(1):231–6.CrossRefPubMed Ruiz-Tovar J, Muñoz JL, Gonzalez J, et al. Postoperative pain after laparoscopic sleeve gastrectomy: comparison of three analgesic schemes (isolated intravenous analgesia, epidural analgesia associated with intravenous analgesia and port-sites infiltration with bupivacaine associated with intravenous analgesia). Surg Endosc. 2017;31(1):231–6.CrossRefPubMed
22.
go back to reference Siddiqui NA, Azami R, Murtaza G, et al. Postoperative port-site pain after gall bladder retrieval from epigastric vs. umbilical port in laparoscopic cholecystectomy: a randomized controlled trial. Int J Surg. 2012;10(4):213–6.CrossRefPubMed Siddiqui NA, Azami R, Murtaza G, et al. Postoperative port-site pain after gall bladder retrieval from epigastric vs. umbilical port in laparoscopic cholecystectomy: a randomized controlled trial. Int J Surg. 2012;10(4):213–6.CrossRefPubMed
23.
go back to reference Keir A, Rhodes L, Kayal A, et al. Does a transversus abdominis plane (TAP) local anaesthetic block improve pain control in patients undergoing laparoscopic cholecystectomy? A best evidence topic. Int J Surg. 2013;11(9):792–4.CrossRefPubMed Keir A, Rhodes L, Kayal A, et al. Does a transversus abdominis plane (TAP) local anaesthetic block improve pain control in patients undergoing laparoscopic cholecystectomy? A best evidence topic. Int J Surg. 2013;11(9):792–4.CrossRefPubMed
24.
go back to reference Manning S, Pucci A. Early postoperative weight loss predicts maximal weight loss after sleeve gastrectomy and Roux-en-Y gastric bypass. Surg Endosc. 2015;29(6):1484–91.CrossRefPubMed Manning S, Pucci A. Early postoperative weight loss predicts maximal weight loss after sleeve gastrectomy and Roux-en-Y gastric bypass. Surg Endosc. 2015;29(6):1484–91.CrossRefPubMed
25.
go back to reference Clinical Issues Committee ASMBS. Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2012;8:e21–6.CrossRef Clinical Issues Committee ASMBS. Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2012;8:e21–6.CrossRef
26.
go back to reference Deitel M, Gagner M, Erickson AL, et al. Third International Summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:749–59.CrossRefPubMed Deitel M, Gagner M, Erickson AL, et al. Third International Summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:749–59.CrossRefPubMed
27.
go back to reference van Rutte PW, Smulders JF, de Zoete JP, et al. Outcome of sleeve gastrectomy as a primary bariatric procedure. Br J Surg. 2014;101(6):661–8.CrossRefPubMed van Rutte PW, Smulders JF, de Zoete JP, et al. Outcome of sleeve gastrectomy as a primary bariatric procedure. Br J Surg. 2014;101(6):661–8.CrossRefPubMed
28.
go back to reference Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149(3):275–87.CrossRefPubMedPubMedCentral Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149(3):275–87.CrossRefPubMedPubMedCentral
Metadata
Title
Bikini Line Sleeve Gastrectomy: Initial Report
Author
Tamer N. Abdelbaki
Publication date
01-12-2017
Publisher
Springer US
Published in
Obesity Surgery / Issue 12/2017
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-017-2941-x

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