Percutaneous and Reduced-Port Roux-en-Y Gastric Bypass: Technical Aspects

Abstract

The well-known advantages of minimally invasive surgery, such as improved surgical vision and precision, less postoperative pain, faster recovery, shorter hospital stay, and reduced parietal complications, are particularly important in bariatric surgery. Patient acceptance and cosmetic results have also been widely demonstrated. The introduction of single-incision laparoscopic surgery and natural orifice transluminal endoscopic surgery, which are aimed at maximizing the benefits of laparoscopy, have generated considerable interest. Unfortunately, the current learning curve and acquisition of specific materials limit the spread of these techniques. The feasibility is well demonstrated but standardization, safety, and long-term results need additional assessment. In addition, there are higher hospital costs and an increased rate of port-site hernia compared with standard laparoscopic surgery, especially for single-incision laparoscopic cholecystectomy. In this context, reduced-port surgery (RPS) with classic laparoscopic triangulation could represent a new target, with no concerns related to procedural safety and surgical outcomes and no additional skills and equipment required. We have already demonstrated the standardization, reproducibility, and safety of RPS in other bariatric procedures. In addition, RPS can lead to better outcomes and avoid potential complications (eg, port-site hernia) that are more deleterious and difficult to manage in these patients. The purpose of this study is to describe our technique of laparoscopic Roux-en-Y gastric bypass (LRYGB) using RPS with percutaneous instrumentation, define the technical details, and analyze the short-term outcomes.