الفهرس 
ObesityOnly 14 pages are availabe for public view
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Abstract
Summary
Morbid obesity is a growing epidemic which is spreading worldwide. This problem has serious associated disorders and morbidities which raised the importance of its management. There are different approaches in the control of obesity including lifestyle change, psychological and behavioral therapy. However, the surgical option has always proved to be the best and most effective in the management of obesity and its comorbidities especially on the long term scale.
Among the various surgical modalities for obesity, the sleeve gastrectomy is considered a widely accepted procedure and its popularity is increasing in the bariatric surgery field. Its short and long term outcomes have shown to be well tolerated with satisfactory body weight control.
The numerous advantages of laparoscopic procedures compared to the open counterparts have inspired an interest in even more minimally invasive surgical approaches. This interest facilitated the birth of needlescopic instruments, natural orifice transluminal endoscopic surgery , and single-access laparoscopy.
Single-access laparoscopy involves the introduction of special multichannel access devices that allow laparoscopic surgery to be performed through one incision, preferably the umbilicus. The potential advantages of this approach are related to limiting the port incisions to one site, in addition to the advantages of traditional minimally invasive surgery.
In the present study we conducted an evaluation of laparoscopic single port sleeve gastrectomy for morbid obese patients regarding its feasibility, safety, technical challenges, advantages and assessment of its effects on weight loss and complications.
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As regards the technique, it was challenging to perform the whole procedure from a single incision. However we managed to introduce a protocol to perform the operation, achieve a full harmony between the operating surgeons and the used instruments. In this way, the surgical obstacles were minimized and our experience was gradually increasing to achieve the best results.
The mean operative time was 92 minutes which was longer in the first number of patients and then reduced with gaining experience in the procedure. 3 patients (10%) were converted to conventional laparoscopic procedure due to technical difficulties. There was no need for open surgery in all patients.
The mean hospital stay was 2.4 days. The substantial reduction in abdominal wall trauma through the introduction of single port through the umbilicus was translated into less postoperative pain, more rapid recovery, less wound complications and of course better cosmetic outcomes.
Early postoperative complications included 6 patients (20%) who suffered from vomiting which was controlled medically in the first 3 days. There was one case of wound infection managed by oral antibiotics.
There were 2 patients who developed incisional hernia and they were managed by repair with mesh. Otherwise there were no more serious complications. The mortality rate was 0%.
The effect of the procedure on body weight was comparable to the results of other single port procedures in literature and even to laparoscopic sleeve gastrectomies. %EWL was 38.3% and 61.43% after 6 and 12 months respectively.