Single-incision sleeve gastrectomy in the treatment of patients with type 2 diabetes mellitus associated with obesity

Abstract

Background. Single‑incision laparoscopic sleeve gastrectomy (LSG) allows the most comfortable conditions for patients in the perioperative period and achieve better cosmetic results, providing the same advantages in terms of metabolic effects as in multiport surgery. Its application requires appropriate skills and a specific material and technical base, therefore, currently there is a limited number of publications on the results of treatment of patients using this technique.
 Objective — to evaluate the results of treatment of patients with obesity‑associated type 2 diabetes mellitus (T2DM) after single‑incision LSG in comparison with multiport LSG.
 Materials and methods. This study included 41 patients with prediabetes or T2DM, who were divided into 2 groups: single port (15 patients) and multiport (26 patients). The following assessments have been performed: body weight and body mass index (BMI); surgery duration; volume of intraoperative blood loss; pain syndrome according to VAS scale on postoperative days 0, 1, 2, and 3; postoperative hospital stay; patient satisfaction with the cosmetic results of surgery according to POSAS scale after 1 month, and T2DM remission according to the level of glycated hemoglobin (HbA1c) one, two, three and five years after surgery.
 Results. There was no significant difference in the volume of intraoperative blood loss (p=0.076) and surgery duration (р=0.59) between the groups. In the single‑incision LSG group, less pronounced pain syndrome was observed with a significant difference starting from the 1 postoperative day (p <0.05), however, the severity of the pain syndrome between two groups on postoperative day 0 did not reach a significant difference (p=0.48). Average postoperative hospital stay in the single‑incision LSG group was significantly lower (p=0.035). At the same time, the cosmetic results of the operation were significantly better in the group of single‑incision LSG (p=0.001). The average level of glycated hemoglobin (HbA1c) in the groups was: for single‑incision group — 6.3±0.7%, and for multiport group — 7.4±1.7% (р=0.02). Normalization of carbohydrate metabolism was observed in the majority of patients involved in the study with a follow‑up period up to 5 years (p <0.01), and only 1 patient (3.8%) in the multiport LSG group had a recurrence of type 2 diabetes after 5 years.
 Conclusions. Single‑incision LSG is an effective and safe operation in patients with obesity‑associated type 2 diabetes. Single‑incision LSG is an acceptable alternative to multiport LSG, if provided by a surgeon who has an experience in performing such operation and after careful selection of patients. Performance of a single‑incision LSG allowed implementation of some aspects of international protocol (intraoperative bilateral subcostal interfascial block, absence of abdominal cavity drainages) into clinical practice, which in turn shortened patient’s hospital stay. Single‑incision LSG allows patients to achieve similar results in remission of type 2 diabetes, while significantly reducing pain in the postoperative period and improving cosmetic results of surgical treatment compared to multiport laparoscopy, which in turn can potentially improve the quality of life of patients and the quality of specialized surgical care to population, and to reduce the risks of fatal cardiovascular complications.