Background: Since 1979, this author has used exclusively a left subcostal incision for gastroplasty (GP) and Roux-en-Y gastric bypass (RYGBP), with complication rates better than published reports in the literature for midline incisions.
Methods and results: From July 1979 through March 1997, 1798 primary GP and RYGBP procedures have been done through the left subcostal incision, in addition to 42 conversions of GP to RYGBP, for a total of 1840 new left subcostal incisions. Comparison with an earlier series revealed no significant changes in results: incision hernias three (0.16%), dehiscence four (0.2%), splenectomy three (0.16%). No splenectomies have been necessary since 1983. Various wound healing problems occurred rarely (2.2%).
Conclusion: The author believes that the left subcostal incision should be the gold-standard of bariatric surgery open procedures.