Single port access sleeve gastrectomy is reasonable!

Dear Sir,

This short letter is in response to the article by Vilallonga.[1] Laparoscopic sleeve gastrectomy (LSG) is an innovative procedure for the management of obesity. It was originally developed as a first-stage bariatric procedure to reduce surgical risk in high-risk patients through the induction of dramatic weight loss. Analysis of the literature suggests that LSG is efficacious in the short-term and may offer certain advantages when compared with the existing options of gastric banding and gastric bypass. These advantages include technical efficiency, lack of an intestinal anastomosis, normal intestinal absorption, no risk of internal hernias, no implantation of a foreign body, pylorus preservation (prevents dumping syndrome), and, finally, LSG may be considered as the most appropriate option in extremely obese patients.[2] Moreover, the entire upper gastrointestinal tract remains accessible for endoscopic assessment. Concerns remain however regarding the risks and important major complications associated with LSG, including staple line leak (1.17%), post-operative haemorrhage (3.57%), and the irreversibility of LSG.[3]

We have performed 10 single-incision LSGs. We used trocar (GelPOINT® advanced access platform), standard straight graspers, and multiple golden 60-mm staplers (Echelon Flex-Ethicon-Endosurgery). A 5-mm extra-large LigaSure Atlas (Covidien) was used in this surgery. The sleeve gastrectomy was started 6 cm from the pylorus. During the dissection along the angle of His, it is not necessary to use a liver retractor because, by lifting the stomach, the liver is automatically pulled up. We did not use continuous suture or tissue reinforcement for the staple line.

And, if you use another trocar, then this is called a double-port access procedure!

However, we put attention to a special patient selection: we only perform this procedure in women with a body mass index of 35–45.