Abstract: Objective:To investigate the feasibility, safety and clinical efficacy of threeport laparoscopic sleeve gastrectomy (TLSG).
Methods:The retrospective crosssectional study was conducted. The clinical data of 104 obese patients who were admitted to the Beijing Friendship Hospital of Capital Medical University between September 2016 and March 2017 were collected. TLSG was performed to all the 104 patients by the same surgical team. The surgical situations, conversion situations (portsite increased or conversion to open surgery), operation time, volume of intraoperative blood loss, surgeryrelated complications, duration of postoperative hospital stay and followup situations were observed. Patients were followed up by Wechat, telephone interview and inpatient examination once at month 3, 6, 9 and 12 postoperatively and once every year after 1 year postoperatively up to April 2017. Followup included weightloss efficacy and postoperative longterm complications. Measurement data with normal distribution were represented as ±s or average (range).
Results:All the 104 patients underwent successful TLSG, without portsite increased or conversion to open surgery. Operation time and volume of intraoperative blood loss were (121±25)minutes and (9±6)mL, respectively. There was no severe intraoperative collateral damage. All the 104 patients with complications were cured by symptomatic treatment, including 1 with portsite infection, 1 with peritoneal effusions causing secondary infection, 3 with improper eatinginduced acute delayed gastric emptying, 6 with fat liquefaction around portsite and 9 with delay healing of portsite. There was no occurrence of severe complications, such as gastrointestinal bleeding, intraabdominal bleeding and gastrostoma. Duration of postoperative hospital stay was (2.4±0.8)days. Eightytwo patients were followed up for 3 months (range, 3-6 months), including 59 with 3month followup, 23 with 6month followup and 22 with under 3month followup. During the followup, there was no portsite hernia. Excess weight loss (EWL) was 37%±11% in 59 patients with 3month followup and 45%±13% in 23 patients with 6month followup. Of 59 patients with 3month followup, 14 patients with diabetes mellitus stopped taking antidiabetic drugs, 10 of 14 patients had complete remission (CR) of hemoglobin Alc (HbAlc) and 4 of 14 patients had partial remission (PR) of HbAlc. Of 23 patients with 6month followup, 6 patients with diabetes mellitus had CR of HbAlc. Of 18 patients with obstructive sleep apnea hypopnea syndrome (OSAHS), 4 had 3month followup, including 3 with CR and 1 was improved to mild OSAHS. Other 14 patients were not evaluated due to inadequate followup time.
Conclusion:TLSG for obese patients with specific indications cannot increase operation time and risk, meanwhile, it can reduce portsite, with a good cosmetic effect.