HOW I DO IT
Bikini Line Sleeve Gastrectomy: Initial Report
Tamer N. A bdelbaki
Published online: 29 September 2017
Springer Science+Business Media, LLC 2017
Background/introduction Several reports have discussed the
potential for reducing port access in laparoscopic sleeve gas-
trectomy (LSG); however, each approach had its innate set-
backs. Aiming at improving the aesthetic outcome, we report
a novel approach to the LSG where we place the trocars at the
bikini line in what we described as bikini line sleeve gastrec-
Methods The present work is a prospective, pilot study on the
use of BLSG in patients, during the period between April and
October 2016. Exclusion criteria included the following: large
hiatal hernia, upper abdominal surgery, and xiphi-umbilical,
xiphi-symphysis pubis, and xiphi-anterior superior iliac spine
distances of > 25,36 and 33 cm, respectively. Four trocars
were used: one at the umbilicus and three at the bikini line.
All laparoscopic graspers were bariatric length instruments
(43 cm). However, camera telescope, endoscopic stapler,
and bipolar dissectors were standard length.
Results Twenty eight patients underwent BLSG. The mean
age was 34.6 ± 3.7 years with a mean BMI of 42.46 kg/
± 3. There were no major intra- or postoperative compli-
cations and no conversion to conventional port site placement.
Patient’s scar satisfaction was favorable. The mean postoper-
ative BMI and weight at 6 m were 28.5 ± 1 kg/m
79.8 kg ± 2, respectively. The mean percentage excess weight
loss at 3, 6, and 12 months were 39.5 ± 4.6, 64.5 ± 5, and
69.8 ± 6%, respectively.
Conclusion BLSG was found to be potentially safe, feasible,
and effective with a favorable aesthetic outcome; it could pos-
sibly be offered to a select group of patients that are conscious
about their scar appearance.
Keywords Sleeve gastrectomy
Bariatric surgery has been continuously evolving with more
than 50 procedures described over the past decades [1, 2].
Nonetheless, bariatric surgeons are still in search for the ideal
bariatric surgical procedure. In parallel, there was a hand-in-
hand evolution in the mode of access in bariatric surgery,
where several reports have discussed the potential for reduc-
ing port access in laparoscopic sleeve gastrectomy (LSG), by
either adopting three ports or a single port approach [3, 4].
However, each approach had its innate setbacks. Among the
setbacks of such techniques is that they can be technically
demanding and can be at a predictably higher cost (requiring
specially designed ports and instruments) [5–7]. In an at-
tempt to make the port site scars in LSG more inconspicuous,
we herein report an approach to perform LSG using conven-
tional ports placed at the lower abdomen in what we de-
scribed as bikini line port access sleeve gastrectomy
(BLSG). The rationale of this manuscript is to describe our
initial experience and to evaluate the feasibility and safety of
this technique. To the best of our knowledge, this is the first
report of such an approach.
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s11695-017-2941-x) contains supplementary
material, which is available to authorized users.
* Tamer N. Abdelbaki
General Surgery Department, Alexandria University Faculty of
Medicine, 11 Hussein Nouh St, Shalalat, Bab Sharki,
OBES SURG (2017) 27:3320–3326