Malabsorptive and Mixed Procedures for Obesity

Laparoscopic bariatric surgery has been introduced since 1992 and is today the gold standard approach for obesity surgery. Single-incision laparoscopy (SIL) has been developed with the aim of further reducing the invasiveness of traditional laparoscopy. The approach through a single intra-umbilical incision was implemented to per- form advanced bariatric procedures such as gastric bypass and biliopancreatic diversion. High technical skill is required for manipulating, measuring, and suturing the bowel with articulated instruments, however emerging technology has contributed to the feasibility of SIL. Minimally invasive techniques have become an integral part of general surgery and proved to be a safe and feasible when compared with multiple ports approach. Cosmesis scores and patient satisfaction showed a preference of patients for SIL. Further benefi t is the positive feedback of this approach on the surgical technique. The need to minimize the manipulation of organs and tissues has led to better under- standing of mechanism of action of the different procedures and to a simplifi cation of the surgical steps. This represents a general benefi t to laparoscopic surgery. We discuss the general approach, the technical details ad the benefi t of SIL in malabsorptive and mixed procedures.