Abstract:

Objective

To investigate the feasibility，safety，and clinical outcomes of a transumbilical horizontal incision in single-incision laparoscopic surgery （SILS） for bariatric procedures.

Methods

Employing a retrospective and descriptive approach，this research analyzed clinical data from 336 patients treated for obesity by single-incision laparoscopic surgery at the Department of Bariatric and Metabolic Surgery in Plastic Surgery Hospital of Chinese Academy of Medical Sciences，between January 2022 and September 2023.The cohort included 87 males and 249 females，with an average age of（37.0±6.5） years and an average BMI of （39.3±6.3） kg/m².Patients' umbilical types were classified through a detailed analysis of photographs.The Scar assessment scales and Ultimate Question questionnaires were used to evaluate scar conditions and patient satisfaction.

Results

All 336 patients successfully underwent transumbilical SILS，including 321 sleeve gastrectomy （SG），6 Roux-en-Y gastric bypass （RYGB），6 single anastomosis duodeno-ileal bypass with sleeve gastrectomy （SADI-S），3 one anastomosis gastric bypass（OAGB），and 28 concomitant cholecystectomies.Umbilical types were classified as horizontal （47.3%），T-shaped （24.4%），oval （17.0%），vertical （4.8%），and distorted （6.5%）.The times for incision opening were 5±3 min and for closing 12±5 min，with total blood loss for these steps being （4±2） mL.Incision-related complications occurred in 6 patients （1.8%），including 3 cases of superficial infections （0.9%），2 of incision dehiscence （0.6%），and 1 of incisional hernia （0.3%）.The average postoperative hospital stay was （3±1）days，with 79% of patients discharged within 3 days postoperatively.The incision's Visual Analog Scale （VAS）scores on postoperative days 0，1，2，and 3 were 2.6，1.5，1.2，and 0.6，respectively.The average total score on the Scar Assessment Scale was 63.5/70，and the average score for the Ultimate Question questionnaires was 8.5/9.

Conclusions

The application of transumbilical horizontal incisions in bariatric surgery for obese patients is demonstrably effective，safe，and aesthetically pleasing，aligning well with the natural anatomy of the umbilicus.

Key words: Obesity, Bariatric Surgery, Laparoscopy, Single Incision, Umbilicus