Abstract
The incidence of morbid obesity is increasing worldwide, and bariatric surgery has proven to be the only effective therapy. Roux-en-Y gastric bypass (RYGB) is regarded as the gold standard bariatric procedure that has stood the test of time. The surgical technique has undergone considerable evolution, and recently, the laparoscopic approach (LRYGB) has become widely popular due to its numerous advantages. The concept of minimal invasiveness with an excellent cosmetic outcome has spurred the recent development of the reduced port and single incision laparoscopic approach. This was initially attempted for basic surgical procedures like cholecystectomy but now has expanded to bariatric surgery as well. Performing LRYGB with a single incision is technically demanding due to loss of triangulation and crowding of trocars and instruments both within and outside the abdomen. This could be partly overcome with the use of commercially available single-incision port devices, low profile trocars, flexible scopes, and curved instruments. The single-incision trans-umbilical (SITU) technique of LRYGB developed innovations like the omega umbilicoplasty, which allows multiple conventional trocars to be placed within the umbilical incision, and the liver suspension tape for retraction of the liver which enables the surgery without specialised instruments. Though comparative studies showed that the SITU-LRYGB had a longer operative time than the conventional technique, it was equally safe and efficacious, with a better cosmetic outcome and wound satisfaction. Future expansion of this approach is expected with further advancements in medical technology.
Published Version
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