Gastric restrictive procedures through a mini-incision: A cost-effective alternative to laparoscopic bariatric surgery in Egypt

Background: Gastric restrictive procedures such as vertical banded gastroplasty (VBG), Roux-en-Y gastric bypass (RYGB) and gastric banding have become the standard in morbid obesity surgery. Surgeons have started to perform these procedures through the laparoscope to give the patient the advantages of smaller incisions, less postoperative pain, shorter hospital stay, and earlier return to work. These laparoscopic procedures have not gained popularity in Egypt because they are more expensive and require longer operating times than open surgery. Instead, we have refined our open surgery technique into a method that gives most of the laparoscopic advantages and yet retains all of the open surgery advantages, i.e., performance of the open procedure through a 7- to 8-cm incision. Methods: From September 1997 to July 1999, 25 morbidly obese patients underwent gastric restrictive procedures through mini-incisions with a follow-up period of less than or equal to 22 months. Twenty-one patients underwent VBG, and 4 patients underwent RYGB. Ninety-two percent of these patients were female, with a mean age of 28.8 years, a mean weight of 117 kg, and a mean body mass index of 45.7 kg/m(2). Results: The operative time was a mean of 56 minutes for the gastroplasty group and a mean of 116 minutes for the bypass group. The mean hospital stay was 3.3 days. Patients returned to normal activity within 15.6 days. Wound infections developed in 3 patients (12%) and incisional hernias in 2 (8%). The total expense of the procedure was one-third to one-half that of the laparoscopic procedure. Conclusion: If cost prevents the wide use of laparoscopic procedures for morbid obesity, performing open procedures through a miniincision is an alternative approach.