Initial learning experience of laparoendoscopic single site (LESS) gastric banding: finding predictors of success.

Cheregi, John R; Tiesenga, Fred; Torquati, Alfonso; Lutfi, Rami

Single-incision laparoscopic adjustable gastric banding (SI-LAGB) is a promising technique with potential to decrease pain and improve cosmesis. It is challenging and potentially time-consuming. We aimed to identify preoperative patient characteristics predictive of a successful SI-LAGB. Demographic and anthropometric data were prospectively collected. Primary endpoint was operating time. Adequate operating time (AOT) was determined using a historic consecutive of 100 subjects undergoing multi-port LAGB. The cutoff for AOT was defined as mean + 1 SD of the historic cohort. Binary logistic regression analysis was used in univariate and multivariate modeling to identify independent preoperative variables associated with AOT. From February 2009 to October 2010, 79 patients (71 female) underwent SI-LAGB, with no conversions to multi-port laparoscopy. Mean operating time was 61 ± 27 min. The cohort was divided into two groups: AOT (n = 53) and excessive operating time, (EOT, n = 26) based on cutoff value of 69 min. On univariate analysis, preoperative BMI had significant (p = 0.03) counterintuitive effect on operative time (AOT 44.2 ± 6.2 kg/m(2) versus EOT 42.1 ± 4.2 kg/m(2)). Hiatal hernia was also significant predictor of EOT (19.2% versus 3.7%; p = 0.001) and remained an independent predictor of EOT in multivariate logistic regression after adjusting for covariates, increasing the chance for EOT by 5.9 times (odd ratio 5.9; 95% CI 1.1-31.1; p = 0.04). SI-LAGB can be performed safely and timely. Concomitant hiatal hernia could be successfully repaired during a SI-LAGB but at the cost of significant additional operating time.