Gastrectomía vertical laparoscópica transumbilical / Transumbilical sleeve gastrectomy: experience in six patients

Background: The transumbilical route can be used to perform sleeve gastrectomies. Aim: To report the experience with transumbilical sleeve gastrectomy. Material and Methods: A prospective protocol of transumbilical sleeve gastrectomy was applied among patients with a body mass index of 36 kg/m² or less, and a distance between the xiphoid process and the umbilicus of less than 22 cm. Results: Six female patients, with a body mass index between 32.5 and 35.3 kg/m² have been operated. The operative time ranged from 90 to 170 min. An additional 5 mm trochar was required in the first two patients. The postoperative barium swallow showed a good distal passage and the absence of stenosis, residual fundus or nitrations in all patients. No patient had complications. Conclusions: Transumbilical sleeve gastrectomy is feasible among patients with a body mass index of less than 36 kg/m².

Introducción: La cirugía laparoscópica ha estado orientada los últimos años a buscar otras alternativas mínimamente invasivas de acceso abdominal. La transumbilical es una vía que ha comenzado a ser aplicada clínicamente, con o sin dispositivos de acceso único. Hemos comenzado a realizar la gastrectomía vertical laparoscópica (GVL) por vía transumbilical, en ciertos casos seleccionados. Objetivo: Evaluar la factibilidad de realizar la GVL por vía transumbilical, utilizando un dispositivo de acceso único y el resto del instrumental laparoscópico tradicional. Método: Protocolo prospectivo aplicado a pacientes que cumplan con criterios de inclusión como: ser candidato a GVL, tener IMC igual o menor a 36 kg/m², distancia entre apéndice xifoides y ombligo menor a 22 cm. El peso promedio de las pacientes operadas fue de 90,5 kg, (82,5-98), IMC promedio de 33,8 kg/m² (32,5-35,3). Se describe la técnica de inserción del dispositivo, de la gastrectomía y del manejo postoperatorio. Resultados: Se logró realizar GVL en las 6 pacientes en las que se intentó. El tiempo operatorio promedio fue de 127 min (90 a 170 min), en las dos primeras pacientes se requirió el uso de un trocar adicional de 5 mm. En todas las pacientes, la radiografía baritada de esófago, estómago y duodeno mostró buen paso a distal y ausencia de estenosis, fondo residual o filtraciones. No hubo morbilidad en este grupo. Conclusiones: La GVL es factible de realizar en pacientes portadores de obesidad menor a 36 kg/ m²de superficie corporal, usando un dispositivo de acceso único e instrumental laparoscópico tradicional.

Laparoscopic vs Transumbilical Single-Port Laparoscopic Appendectomy; Results of Prospective Randomized Trial

PURPOSE: Conventional three-port laparoscopic appendectomy (LA) is more commonly performed than transumbilical single port laparoscopic appendectomy (TUSPLA). In this report, we performed a prospective randomized study comparing the outcomes of LA and TUSPLA. METHODS: Between April 14, 2009 and June 10, 2009, 40 patients who required laparoscopic appendectomies were randomly selected to receive either a TUSPLA or a LA. None of these patients had perforation or abscess. Twenty of the patients received a LA and the other 20 received a TUSPLA. The clinical outcomes and visual analog pain scores (VAS) were compared between the groups. RESULTS: The TUSPLA procedures were performed successfully in every indicated patient. Clinical outcomes were similar in both study groups. The TUSPLA group showed a significantly higher VAS score 24 hours postoperatively than the LA group. CONCLUSION: Compared with LA, TUSPLA was technically feasible and safe in patients with non-complicated appendicitis. However, the patients in the TUSPLA group reported more postoperative pain than those in the LA group.