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Single Incision (Scarless) Laparoscopic Surgery - Sleeve Gastrectomy

Single incision surgery or single-incision laparoscopic bariatric (sleeve gastrectomy) surgery is one of the most spectacular innovations in the field of minimal access surgery. As the name suggests single incision surgery is performed through a single incision in the navel. It is essentially a scarless procedure as the scar gets hidden deep into the navel. Among the bariatric procedures, sleeve gastrectomy is the most commonly performed procedure using this technique.

Dr. Lakdawala enjoys the distinction of pioneering the largest series of Single Incision Laparoscopic Surgeries (SILS) in Asia and the world with an incredible success rate.

How is it performed?
The surgery is performed through a 2 cm vertical incision in the navel. Specialized ports that are custom made for single incision surgery are used. The surgical steps remain the same as in conventional laparoscopic sleeve gastrectomy.
Are there any risk factors surrounding this surgery?
This surgery is technically very demanding and must be performed by surgeons with enough experience in conventional laparoscopic sleeve gastrectomy. It is a very safe procedure in good hands and leads to fabulous results. In a study conducted at our center, we compared the results between single incision sleeve gastrectomy with laparoscopic sleeve gastrectomy. We found that the excess weight loss and complication rates were similar in both techniques of surgery. The patients with Single incision surgery were happier and more satisfied with their (barely visible) scar. They also had much lesser pain in the postoperative period.
When is a patient recommended to undergo this surgery?
Patients with a BMI of up to 60 Kg/m2 can have this surgery. Patients who are ‘super superobese’ or those who have had a previous major abdominal surgery are not recommended this procedure. It is favoured by the younger demographic, especially younger women (since scarring is barely visible).
What are the pre-surgery and post-surgery procedures and are there any precautions or alterations to one’s lifestyle that the patient has to make?
Pre and post-surgery procedures are the same as conventional laparoscopic sleeve gastrectomy. Patients need to be on a high protein low carbohydrate diet for 7 days before the surgery. After the surgery they need to be on liquids for 15 days followed by semisolids and eventually onto full diet after a month. After sleeve gastrectomy they may need nutritional supplements for about 3 to 4 months after the surgery. The procedure pushes the patients into a healthier lifestyle. It is imperative to have small frequent meals. High calorie foods and drinks must be avoided.
Post-surgery what are the chances of the patient gaining weight?
The surgery helps in knocking off about 80% of the excess weight. Weight gain usually happens due to the “soft calorie syndrome” where patients consume large quantities of liquid calories such as cola drinks, alcohol, ice cream etc. Sleeve gastrectomy is a restrictive procedure and soft foods and liquids can pass easily through the reduced stomach. Sometimes there can be technical problems with the sleeve per se. If the pouch is too large or the fundus of the stomach has been left behind, then the patients may gain weight at a later stage.
Sleeve gastrectomy can be easily converted to other bariatric procedures such as roux en y gastric bypass or a duodenal switch in cases of extreme weight gain.
When can one undergo this surgery and are there any health problems due to which this surgery cannot be performed?
Single incision sleeve gastrectomy can be performed for all patients with a BMI of up to 60 Kg/m2.
At our center, only patients who are super super obese or those who have excessive intra-abdominal scarring are excluded. Bariatric surgery is usually not advised for patients who have a serious psychiatric disorder, patients with history of substance abuse and chronic smokers.
How many patients at CODS have opted for SILS?
We at CODS have performed the SILS procedure on close to 60 patients (the largest series of its kind in India and Asia).

Single Incision Sleeve Gastrectomy versus Conventional Laparoscopic Sleeve Gastrectomy
- A randomised pilot study by M. Lakdawala, N.H. Muda, S. Goel, A.
Bhasker. 10.1007/s11695-011-0478-y.

Read the paper abstract here

Charmine (Cochin) 1st lady to undergo SILS from Asia
1st lady to undergo SILS from Asia
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