LAUSR

Obesity is a disease that has reached epidemic proportions worldwide, carrying an important health and financial burden for society. In 2012, about 6.9 million people met the criteria for obesity in France, representing a 76% increase since 1997 [1]. Liver transplanted patients are not spared by this issue. Lifetime immunosuppressive treatment after liver transplantation (LT) can be considered as a risk factor for obesity [2]. Furthermore, obesity and some of its related comorbidities, such as type 2 diabetes, induce non-alcoholic fatty liver disease (NAFLD) which is an important risk factor of non-alcoholic steatohepatitis (NASH), liver cirrhosis, and hepatocellular carcinoma (HCC) [3]. Consequently, in addition to the devastating impact on quality of life and increasing cardiovascular risk, obesity exposes these patients to future graft loss. Protection of the graft in obese LT patients by determining the optimal way of weight loss represents an immense challenge for bariatric and liver transplant surgeons. Laparoscopic sleeve gastrectomy (LSG) has become increasingly popular for the treatment of morbid obesity. It is considered more rapid, simpler, and less invasive than the gastric bypass. Literature reports on the feasibility and excellent weight loss after LSG have been accumulating over the past years [4]. Its relatively low complexity, performed in only one abdominal quadrant with limited movement range, has made it a good candidate for single-incision laparoscopic surgery (SILS). Apart from cosmetic benefits, potential advantages of SILS over conventional laparoscopy are less postoperative pain, shorter hospital stay, and faster return to professional activity [5]. However, this approach has been often criticized for complexity in achieving optimal triangulation, difficulties in dissection and exposure related to abundant subcutaneous and visceral fat, and need for liver retraction, which could lead to suboptimal sleeve construction and consequently worse outcomes. We have recently developed a singleincision technique for LSG which is carefully standardized in order to be reproducible and suitable for routine practice [6]. Few publications suggest a role for LSG after LT for weight loss and obesity-related comorbidities remission [7, 8]. The potential benefits of single-port sleeve gastrectomy (SPSG) have never been discussed for this specific type of patients. We therefore aim to report our first experience of SPSG in a morbidly obese LT patient.