Initial experience with two-incision laparoscopic adjustable gastric banding
Presented as a poster at the Annual Meeting of the American Society Metabolic and Bariatric Society, Grapevine, Texas 2009
Received 19 March 2009; received in revised form 25 May 2009; accepted 26 May 2009. published online 05 June 2009.
Abstract
Background
To introduce the 2-incision technique for laparoscopic adjustable gastric banding (LAGB) and report our experience with 25 consecutive patients. Newer applications of minimally invasive laparoscopic techniques have been touted as revolutionary.
Methods
We have introduced a technique for LAGB that uses 2 skin incisions: 1 incision in the right upper quadrant (2.5 cm) that accommodates 2 trocars (11 and 5 mm) through which the dissection and implantation of the band were undertaken, and a 0.5-cm incision in the left upper quadrant for the 5-mm videoscope. The band reservoir was placed in a subcutaneous pocket through the upper quadrant incision. Previously, we used a standard 5-incision technique: 2 in the right upper quadrant, 2 in the left paramedian, and 1 in the subxyphoid area to retract the liver. The data from 25 consecutive 2-incision LAGB procedures (October 2007 to April 2008) were compared with the data from 19 consecutive standard 5-incision LAGB procedures (July 2007 to October 2007). The data are presented as mean ± SD. The t test was used to compare the mean values, and P <.05 was considered significant.
Results
The mean estimated blood loss in the 2-incision LAGB was 54 ± 2 mL compared with 17 ± 1 mL in the standard technique (P = .040). The mean operating time for the 2-incision LAGB was 119 ± 1 minutes compared with 103 ± 1 minutes for the standard technique (P = .047). No mortality or procedure-related complications (e.g., erosion, slippage) occurred in the 2 groups.
Conclusion
Two-incision LAGB is feasible; however, it is associated with an increased operating time and blood loss. The operating time and blood loss might improve with standardization of the operative technique and introduction of newly designed flexible tip instruments. Additional prospective studies with a larger sample size are needed to assess the efficacy and benefit of the 2-incision technique versus the standard technique.
Weight Management and Metabolic Health Center, University of South Florida, Health Sciences Center, Tampa, Florida
Reprint requests: Michel M. Murr, M.D., F.A.C.S., Department of Surgery, University of South Florida, Tampa General Hospital, P.O. Box 1289, Suite F-145, Tampa, FL 33601
Drs. Ajami and Bakhos contributed equally to this article.
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