Clinical application of unsymmetrical four<b>-</b>port laparoscopic sleeve gastrectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 BAO Feng , RUAN Min , DENG Zhigang , XIANG Chunhua , ZHI Xing , SHANG Jianying

Department of General Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan 621000, P. R. China;

Corresponding?author：

BAO Feng, Email: baofeng_student@163.com

Keywords：

obesity; bariatric surgery; four-port method; sleeve gastrectomy; laparoscopy

DOI：

10.7507/1007-9424.202210029

Video：

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Objective To investigate the clinical application value of unsymmetrical four-port laparoscopic sleeve gastrectomy (LSG). Methods The clinical data of 114 patients with obesity who were admitted to Mianyang Central Hospital from June 2021 to May 2022 were retrospective analyzed. All the 114 patients underwent unsymme-trical four-port LSG, and were observed their surgical and postoperative conditions, complications and follow-up the patient’s esthetic satisfaction of wounds at 3 months after surgery. Results All 114 patients underwent unsymmetrical four-port LSG successfully, without conversion to open surgery. The operative time was 68–160 min, average (104.2±26.1) minutes; volume of intraoperative blood loss was 2–50 mL, average (10.7±7.6) mL; the duration of postoperative hospital stay was 3–6 d, average (4.0±0.7) days. Of the 114 patients, 8 patients (7.0%) had fat liquefaction of wounds, 68 patients (59.6%) had postoperative nausea and vomiting in the 24 hours after operation, and all patients had no serious complications such as gastrointestinal bleeding, intraperitoneal hemorrhage, or gastric leakage. One hundred and fourteen patients were followed-up for 3–14 months, with a median follow-up of 6 months. Forty patients (35.1%) had hair loss, 3 patients (2.6%) had mild anemia. Of the 114 patients, 2 (1.8%) were dissatisfied with the cosmetic effects of wounds, 64 (56.1%) were satisfied, and 48 (42.1%) were very satisfied. The satisfaction rate was 98.2% (112/114). Conclusion The unsymmetrical four-port LSG is safe and feasible, it does not affect esthetic satisfaction of wounds.

Citation： BAO Feng, RUAN Min, DENG Zhigang, XIANG Chunhua, ZHI Xing, SHANG Jianying. Clinical application of unsymmetrical four-port laparoscopic sleeve gastrectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(3): 268-272. doi: 10.7507/1007-9424.202210029 Copy

1.	Gagner M, Rogula T. Laparoscopic reoperative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg, 2003, 13(4): 649-654.
2.	English WJ, DeMaria EJ, Hutter MM, et al. American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis, 2020, 16(4): 457-463.
3.	Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures—2019 update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring), 2020, 28(4): O1-O58.
4.	Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obesity surgery, 2015, 25(10): 1822-1832.
5.	中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會, 中國肥胖代謝外科研究協作組. 中國肥胖代謝外科數據庫: 2021年度報告. 中華肥胖與代謝病電子雜志, 2022, 8(1): 15-23.
6.	Soong TC, Lee MH, Lee WJ, et al. Long-term efficacy of bariatric surgery for the treatment of super-obesity: Comparison of SG, RYGB, and OAGB. Obes Surg, 2021, 31(8): 3391-3399.
7.	Lee Y, Doumouras AG, Yu J, et al. Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass: A systematic review and meta-analysis of weight loss, comorbidities, and biochemical outcomes from randomized controlled trials. Ann Surg, 2021, 273(1): 66-74.
8.	Uhe I, Douissard J, Podetta M, et al. Roux-en-Y gastric bypass, sleeve gastrectomy, or one-anastomosis gastric bypass? A systematic review and meta-analysis of randomized-controlled trials. Obesity (Silver Spring), 2022, 30(3): 614-627.
9.	Chaar ME, Lundberg P, Stoltzfus J. Thirty-day outcomes of sleeve gastrectomy versus Roux-en-Y gastric bypass: first report based on Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Surg Obes Relat Dis, 2018, 14(5): 545-551.
10.	Felsenreich DM, Bichler C, Langer FB, et al. Sleeve gastrectomy: surgical technique, outcomes, and complications. Surg Technol Int, 2020, 36: 63-69.
11.	王存川, 張鵬, 趙玉沛. 腹腔鏡袖狀胃切除術操作指南(2018版). 中華肥胖與代謝病電子雜志, 2018, 4(4): 196-201.
12.	王勇, 王存川, 朱曬紅, 等. 中國肥胖及2型糖尿病外科治療指南(2019版). 中國實用外科雜志, 2019, 39(4): 301-306.
13.	中華醫學會腸外腸內營養學分會營養與代謝協作組, 北京協和醫院減重多學科協作組. 減重手術的營養與多學科管理專家共識. 中華外科雜志, 2018, 56(2): 81-90.
14.	馮志英, 王建榮, 張黎明, 等. 住院患者護理工作滿意度量表的研制. 中華護理雜志, 2007, 42(1): 63-66.
15.	Tranchart H, Rebibo L, Gaillard M, et al. Short-term outcomes of single-port versus conventional laparoscopic sleeve gastrectomy: a propensity score matched analysis. Surg Endosc, 2020, 34(9): 3978-3985.
16.	高磊, 胡揚喜, 胡德升, 等. 對稱3孔法腹腔鏡袖狀胃切除術的臨床應用價值. 中華消化外科雜志, 2019, 18(9): 854-858.
17.	Consalvo V, Salsano V, Sarno G, et al. Three-trocar sleeve gastrectomy vs standard five-trocar technique: a randomized controlled trial. Obes Surg, 2017, 27(12): 3142-3148.
18.	Spivak H, Segev L, Meydan C, et al. Achieving the “minimal scarring” concept in bariatrics by port-site relocation. Obes Surg, 2016, 26(3): 683-687.
19.	吳立勝, 余建偉, 李煜, 等. 胃后壁優先分離四孔法腹腔鏡袖狀胃切除術(附122例報告). 外科理論與實踐, 2020, 25(5): 422-425.
20.	Seymour KA, Turner MC, Kuchibhatla M, et al. Gastroesophageal reflux predicts utilization of dehydration treatments after bariatric surgery. Obes Surg, 2021, 31(2): 838-846.
21.	Suh S, Helm M, Kindel TL, et al. The impact of nausea on post-operative outcomes in bariatric surgery patients. Surg Endosc, 2020, 34(7): 3085-3091.
22.	郭海軍, 朱江帆, 馬穎璋, 等. 肥胖癥腹腔鏡胃袖狀切除術后脫發相關危險因素分析. 中華消化外科雜志, 2017, 16(6): 592-595.
23.	Ruiz-Tovar J, Oller I, Llavero C, et al. Hair loss in females after sleeve gastrectomy: predictive value of serum zinc and iron levels. Am Surg, 2014, 80(5): 466-471.
24.	?en O, Türk?apar AG. Hair loss after sleeve gastrectomy and effect of biotin supplements. J Laparoendosc Adv Surg Tech A, 2021, 31(3): 296-300.
25.	Katsogridaki G, Tzovaras G, Sioka E, et al. Hair loss after laparoscopic sleeve gastrectomy. Obes Surg, 2018, 28(12): 3929-3934.
26.	Zhang W, Fan M, Wang C, et al. Hair loss after metabolic and bariatric surgery: a systematic review and meta-analysis. Obes Surg, 2021, 31(6): 2649-2659.

1. Gagner M, Rogula T. Laparoscopic reoperative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg, 2003, 13(4): 649-654.
2. English WJ, DeMaria EJ, Hutter MM, et al. American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis, 2020, 16(4): 457-463.
3. Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures—2019 update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring), 2020, 28(4): O1-O58.
4. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obesity surgery, 2015, 25(10): 1822-1832.
5. 中國醫師協會外科醫師分會肥胖和糖尿病外科醫師委員會, 中國肥胖代謝外科研究協作組. 中國肥胖代謝外科數據庫: 2021年度報告. 中華肥胖與代謝病電子雜志, 2022, 8(1): 15-23.
6. Soong TC, Lee MH, Lee WJ, et al. Long-term efficacy of bariatric surgery for the treatment of super-obesity: Comparison of SG, RYGB, and OAGB. Obes Surg, 2021, 31(8): 3391-3399.
7. Lee Y, Doumouras AG, Yu J, et al. Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass: A systematic review and meta-analysis of weight loss, comorbidities, and biochemical outcomes from randomized controlled trials. Ann Surg, 2021, 273(1): 66-74.
8. Uhe I, Douissard J, Podetta M, et al. Roux-en-Y gastric bypass, sleeve gastrectomy, or one-anastomosis gastric bypass? A systematic review and meta-analysis of randomized-controlled trials. Obesity (Silver Spring), 2022, 30(3): 614-627.
9. Chaar ME, Lundberg P, Stoltzfus J. Thirty-day outcomes of sleeve gastrectomy versus Roux-en-Y gastric bypass: first report based on Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Surg Obes Relat Dis, 2018, 14(5): 545-551.
10. Felsenreich DM, Bichler C, Langer FB, et al. Sleeve gastrectomy: surgical technique, outcomes, and complications. Surg Technol Int, 2020, 36: 63-69.
11. 王存川, 張鵬, 趙玉沛. 腹腔鏡袖狀胃切除術操作指南(2018版). 中華肥胖與代謝病電子雜志, 2018, 4(4): 196-201.
12. 王勇, 王存川, 朱曬紅, 等. 中國肥胖及2型糖尿病外科治療指南(2019版). 中國實用外科雜志, 2019, 39(4): 301-306.
13. 中華醫學會腸外腸內營養學分會營養與代謝協作組, 北京協和醫院減重多學科協作組. 減重手術的營養與多學科管理專家共識. 中華外科雜志, 2018, 56(2): 81-90.
14. 馮志英, 王建榮, 張黎明, 等. 住院患者護理工作滿意度量表的研制. 中華護理雜志, 2007, 42(1): 63-66.
15. Tranchart H, Rebibo L, Gaillard M, et al. Short-term outcomes of single-port versus conventional laparoscopic sleeve gastrectomy: a propensity score matched analysis. Surg Endosc, 2020, 34(9): 3978-3985.
16. 高磊, 胡揚喜, 胡德升, 等. 對稱3孔法腹腔鏡袖狀胃切除術的臨床應用價值. 中華消化外科雜志, 2019, 18(9): 854-858.
17. Consalvo V, Salsano V, Sarno G, et al. Three-trocar sleeve gastrectomy vs standard five-trocar technique: a randomized controlled trial. Obes Surg, 2017, 27(12): 3142-3148.
18. Spivak H, Segev L, Meydan C, et al. Achieving the “minimal scarring” concept in bariatrics by port-site relocation. Obes Surg, 2016, 26(3): 683-687.
19. 吳立勝, 余建偉, 李煜, 等. 胃后壁優先分離四孔法腹腔鏡袖狀胃切除術(附122例報告). 外科理論與實踐, 2020, 25(5): 422-425.
20. Seymour KA, Turner MC, Kuchibhatla M, et al. Gastroesophageal reflux predicts utilization of dehydration treatments after bariatric surgery. Obes Surg, 2021, 31(2): 838-846.
21. Suh S, Helm M, Kindel TL, et al. The impact of nausea on post-operative outcomes in bariatric surgery patients. Surg Endosc, 2020, 34(7): 3085-3091.
22. 郭海軍, 朱江帆, 馬穎璋, 等. 肥胖癥腹腔鏡胃袖狀切除術后脫發相關危險因素分析. 中華消化外科雜志, 2017, 16(6): 592-595.
23. Ruiz-Tovar J, Oller I, Llavero C, et al. Hair loss in females after sleeve gastrectomy: predictive value of serum zinc and iron levels. Am Surg, 2014, 80(5): 466-471.
24. ?en O, Türk?apar AG. Hair loss after sleeve gastrectomy and effect of biotin supplements. J Laparoendosc Adv Surg Tech A, 2021, 31(3): 296-300.
25. Katsogridaki G, Tzovaras G, Sioka E, et al. Hair loss after laparoscopic sleeve gastrectomy. Obes Surg, 2018, 28(12): 3929-3934.
26. Zhang W, Fan M, Wang C, et al. Hair loss after metabolic and bariatric surgery: a systematic review and meta-analysis. Obes Surg, 2021, 31(6): 2649-2659.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical application of unsymmetrical four-port laparoscopic sleeve gastrectomy

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