MDNews - Cleveland-Akron-Canton

++ + ++ + ++++++++++++++++++++++++++++++++++++++++++++++  SPECIAL SECTION: DIABETES AND OBESITY ++++++++++++++++++++++++++++++++++++++++++++++ + + SINGLE INCISION LAPAROSCOPIC SLEEVE GASTRECTOMY: THE MINIMALLY INVASIVE WEIGHT LOSS SOLUTION By Alan A Saber, MD, MS, FACS, FASMBS with its associated comorbidities, is a chronic condition requiring treat- ment. Conservative treatment has been shown in long-term studies to be ineffective with relapse rates of up to 90 percent. Surgical treatment of morbid obesity, on the other hand, has been shown to produce substantial sustained weight loss, reduction in associated comorbidities, and can increase the life expectancy and quality of life for extremely obese individuals. Bariatric surgery is an evolving fi eld C with new techniques and is constantly developing. Laparoscopic sleeve gas- trectomy is an emerging new bariatric procedure. It involves removal of the lateral 90 percent of the stomach. This will restrict the food intake and decrease the appetite. The hormonal effects of sleeve gastrectomy are more prominent than that of the current gold standard bariatric procedure, i.e. Roux en Y gastric bypass. The markedly reduced ghrelin hormone levels in addition to increased PYY levels after sleeve gastrectomy are associated with greater appetite suppression and excess weight loss compared with gastric bypass. Studies report a weight loss from laparoscopic sleeve gastrectomy of 69 percent excess body weight loss at 12 months and 53 percent at six years. Sleeve gastrectomy has several advantages over current weight loss URRENTLY, MORE THAN 15 million adult American suffer from severe obesity (BMI >35 kg/m2). Obesity, along procedures. Unlike gastric bypass, sleeve gastrectomy does not involve rerouting of the intestine or malabsorbtion, thus it does not affect absorption of food, vita- mins or medications. In addition, gastric sleeve does not have the risk of internal hernia, marginal ulcer or dumping syndrome. Unlike gastric band, sleeve gastrectomy neither involves placement of a device nor required adjustments. The simplicity of the procedure and the decreased risk profi le make gastric sleeve very appealing. The numerous advantages of laparo- scopic procedures compared to their open counterparts have inspired an interest in even more minimally inva- sive surgical approaches. This interest facilitated the birth of single incision laparoscopy allowing laparoscopic surgery to be performed through one small incision inside the umbilicus. Single-incision laparoscopic surgery (SILS) sleeve gastrectomy is a novel approach that has been gaining popu- larity since its development in 2008. Performing the procedure through a single small incision results in substantial reduction in abdominal wall trauma. This translates into less postoperative pain, less need for analgesic, shorter hospital stays and quicker recovery than the conventional laparoscopic approach. Placing the incision inside the umbilicus results in an invisible scar, essentially. This improves the cosmetic outcome, the power of privacy, the self-esteem and the body image of morbidly obese patients. The cosmetic aspect of SILS bariatric surgery is very important because 80 percent of bariatric patients are females. The single incision approach requires a certain set of surgical skills. In expert hands, single incision laparoscopic sleeve gastrectomy is a safe and feasible procedure. It has all the advantages of sleeve gastrectomy in addition to all of the advantages of the single incision laparoscopic approach. Dr. Alan Saber is director of Metabolic Surgery at University Hospitals Case Medical Center and Associate Professor of Surgery at Case Western Reserve University School of Medicine. He is credited with developing the single-incision laparoscopic surgery (SILS) sleeve gastrectomy. n References: 1. Miller K, Hell E. Laparoscopic surgical concepts of morbid obesity. Langenbecks Arch Surg 2003;388:375-84. 2. Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008 Mar;247(3):401-7. 3. Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010; 252(2):319–324. 4. Saber AA, Elgamal MH, Itawi EA, Rao AJ. Single- incision laparoscopic sleeve gastrectomy (SILS): a novel technique. Obes Surg. 2008;18:1338–1342. 5. Saber AA, El-Ghazaly TH, Dewoolkar AV, Slayton SA. Single-incision laparoscopic sleeve gastrectomy versus conventional multiport laparoscopic sleeve gastrectomy: technical considerations and strategic modifi cations. Surg Obes Relat Dis. 2010; 6(6): 658–664. MDNEWS.COM  JULY-AUGUST 2011  MD NEWS Cleveland-Akron-Canton | 45

• Cover