Letters to the Editor: Surgeons Should Exercise Caution When Performing SILS

Dear Bariatric Times Editor:

I was duly impressed with the advanced laparoscopic skills demonstrated by the authors of the article “Single-incision Laparoscopic Sleeve Gastrectomy” in your February 2011 edition of Bariatric Times. Their successful completion of a challenging operation safely testifies to their technical abilities.Over the past 20 plus years in active bariatric surgical practice I have seen great advances in technique and have embraced them after appropriate clinical experience has proven them superior to the open techniques we practiced not so many years ago. I refer to the laparoscopic Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric band (LAGB), and laparoscopic revisional procedures, which are a routine part of my practice today. The improved visibility and decreased postoperative pain associated with the laparoscopic approach has stood the test of time.

I am concerned about the cavalier acceptance of single-incision laparoscopic surgery (SILS) techniques in the bariatric population. It seems we are taking operations, which we can perform safely and with minimal scarring, and sacrificing good visualization and safe technique to embrace the challenge of a more difficult surgical approach, simply for the sake of the technical challenge. When the SILS approach was applied to the more simple procedure of cholecystectomy, we saw an increased complication rate to include common bile duct injury reported in the literature. In the population with morbid obesity, the argument that SILS is more cosmetic is laughable.

My personal experience, being close to a large tertiary referral center, which advertises the SILS procedures and robotic procedures, has been to assume the care of several patients who have developed hernias after these procedures. The scarring I have seen is certainly no more cosmetically appealing than that of several small trocar sites.

I recognize that by suggesting caution I am opening myself to criticism by the younger, bolder, and possibly more cavalier surgeons anxious to establish their place in the developmental history of surgery, but I would counsel my younger colleagues: “First do no harm.”

With regards,

William M. Steely MD, FACS
Director of Bariatric Surgery
Gateway Medical Center
Clarksville, Tennessee

Category: Letters to the Editor, Past Articles