ABSTRACT
SUMMARY OBJECTIVE The gold standard technique for laparoscopic cholecystectomy (LC) is using four ports in the upper abdomen. However, this operative approach may not provide aesthetic satisfaction for some patients because of visible incision marks. This study sought to demonstrate that these incision marks can be hidden by safely changing the port locations. METHODS For patients with symptomatic cholelithiasis undergoing LC between March 2019 and March 2020, the modified bikini line approach was used. With the patient in the supine position with open legs, the first trocar (10 mm) was inserted into the abdomen through an 11-mm incision in the umbilicus. The other three trocars were placed in the abdomen at the bikini line with the help of a camera. The standard equipment for LC was then used to perform the surgery. RESULTS The modified bikini line approach to LC was used for 38 patients. Average operative time was 28.65 min, and the average hospital stay was 1.07 days. No perioperative or postoperative complications occurred. Follow-up was at 1 week, 1 month, and 6 months. Cosmetic results were satisfactory for all patients. CONCLUSIONS As an alternative to the standard LC approach, the modified bikini line technique is safe and useful in patients for whom postoperative aesthetic appearance is important. The modified approach is simple to learn and use and is effective to hide the incision marks well.
Subject(s)
Humans , Cholelithiasis/surgery , Cholecystectomy, Laparoscopic , Postoperative Complications , Treatment Outcome , Operative Time , Length of StayABSTRACT
Objective@#To investigate the application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy.@*Methods@#The retrospective cohort study was conducted. The clinical data of 162 patients with obesity and metabolic diseases who were admitted to the First Affiliated Hospital of Jinan University between March 2018 and April 2019 were collected. There were 51 males and 111 females, aged (35±8)years, with a range from 12 to 47 years. Of 162 patients, 72 undergoing laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incisional approach and 90 undergoing laparoscopic sleeve gastrectomy via traditional incisional approach were respectively allocated into concealed incision group and traditional incision group. Observation indicators: (1) surgical situations; (2) intraoperative situations; (3) postoperative situations; (4) follow-up. Follow-up using outpatient examination, telephone interview, and WeChat was performed to detect the postoperative complications at 1, 3, 6 months and 1, 2, 5 years postoperatively up to May 2019. Measurement data with normal distribution were represented as Mean±SD, and the t test was used for comparison between groups. Count data were represented as absolute numbers, and were analyzed by the chi-square test or fisher exact probability. Ordinal data were analyzed by the Wilcoxon rank sum test.@*Results@#(1) Surgical situations: patients in the concealed incision group and traditional incision group underwent successfully laparoscopic sleeve gastrectomy, without conversion to open surgery, reoperation, or perioperative death. (2) Intraoperative situations: the operation time and volume of intraoperative blood loss of the concealed incision group were (102±17)minutes and (11±4)mL, respectively, versus (105±19)minutes and (11±4)mL of the traditional incision group (t=-1.232, -0.676, P>0.05). There were 6 cases and 21 cases with additional surgical ports during operation in the concealed incision group and traditional incision group, respectively, with a significant difference between the two groups (χ2=6.280, P<0.05). (3) Postoperative situations: in the concealed incision group, 56 patients were very satisfied with scar appearance and 16 patients were satisfied with scar appearance. In the traditional incision group, 42 patients were very satisfied with scar appearance and 48 patients were satisfied with scar appearance. There was a significant difference in the overall satisfaction with the incision scar between the two groups (Z=-4.012, P<0.05). Duration of postoperative hospital stay and total hospital expenses of the concealed incision group were (4.9±0.9)days and (64 408±5 123)yuan, versus (5.2±1.5)days and (64 953±3 477)yuan of the traditional incision group (t=-1.788, -0.804, P>0.05). There were 19 and 14 patients with gastroesophageal reflux in the concealed incision group and traditional incision group, respectively, with no significant difference between the two groups (χ2=2.894, P>0.05). There was no postoperative complication such as infection, hemorrhage or anastomotic leakage in either group. (4) Follow-up: 32 of 162 patients were lost to follow-up, including 10 in the concealed incision group and 22 in the traditional incision group; other 130 patients were followed up for 1-14 months, with a median follow-up time of 7 months. During the follow-up, 1 patient in the traditional incision group was hospitalized again at 3 months after surgery due to upper gastrointestinal bleeding, and was cured after symptomatic supportive treatment. One patient in the concealed incision group was admitted to the local hospital for functional obstruction at 1 month after surgery and was discharged after symptomatic treatment. Other patients had no readmission due to postoperative complications.@*Conclusion@#Laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incision is safe and feasible, with good cosmetic effects.
ABSTRACT
Objective To investigate the application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy.Methods The retrospective cohort study was conducted.The clinical data of 162 patients with obesity and metabolic diseases who were admitted to the First Affiliated Hospital of Jinan University between March 2018 and April 2019 were collected.There were 51 males and 111 females,aged (35± 8)years,with a range from 12 to 47 years.Of 162 patients,72 undergoing laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incisional approach and 90 undergoing laparoscopic sleeve gastrectomy via traditional incisional approach were respectively allocated into concealed incision group and traditional incision group.Observation indicators:(1) surgical situations;(2) intraoperative situations;(3) postoperative situations;(4) follow-up.Follow-up using outpatient examination,telephone interview,and WeChat was performed to detect the postoperative complications at 1,3,6 months and 1,2,5 years postoperatively up to May 2019.Measurement data with normal distribution were represented as Mean±SD,and the t test was used for comparison between groups.Count data were represented as absolute numbers,and were analyzed by the chisquare test or fisher exact probability.Ordinal data were analyzed by the Wilcoxon rank sum test.Results (1) Surgical situations:patients in the concealed incision group and traditional incision group underwent successfully laparoscopic sleeve gastrectomy,without conversion to open surgery,reoperation,or perioperative death.(2) Intmoperative situations:the operation time and volume of intraoperative blood loss of the concealed incision group were (102± 17) minutes and (11±4) mL,respectively,versus (105± 19) minutes and (11 ±.4) mL of the traditional incision group (t=-1.232,-0.676,P＞0.05).There were 6 cases and 21 cases with additional surgical ports during operation in the concealed incision group and traditional incision group,respectively,with a significant difference between the two groups (x2=6.280,P＜0.05).(3) Postoperative situations:in the concealed incision group,56 patients were very satisfied with scar appearance and 16 patients were satisfied with scar appearance.In the traditional incision group,42 patients were very satisfied with scar appearance and 48 patients were satisfied with scar appearance.There was a significant difference in the overall satisfaction with the incision scar between the two groups (Z =-4.012,P＜0.05).Duration of postoperative hospital stay and total hospital expenses of the concealed incision group were (4.9±0.9) days and (64 408±5 123) yuan,versus (5.2± 1.5) days and (64 953± 3 477)yuan of the traditional incision group (t =-1.788,-0.804,P＞0.05).There were 19 and 14 patients with gastroesophageal reflux in the concealed incision group and traditional incision group,respectively,with no significant difference between the two groups (x2=2.894,P＞0.05).There was no postoperative complication such as infection,hemorrhage or anastomotic leakage in either group.(4) Follow-up:32 of 162 patients were lost to follow-up,including 10 in the concealed incision group and 22 in the traditional incision group;other 130 patients were followed up for 1-14 months,with a median follow-up time of 7 months.During the follow-up,1 patient in the traditional incision group was hospitalized again at 3 months after surgery due to upper gastrointestinal bleeding,and was cured after symptomatic supportive treatment.One patient in the concealed incision group was admitted to the local hospital for functional obstruction at 1 month after surgery and was discharged after symptomatic treatment.Other patients had no readmission due to postoperative complications.Conclusion Laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incision is safe and feasible,with good cosmetic effects.