7% of all conversions) with a total rate of 5.2% and 2.6%, respectively [6]. The lack of an adequate identification of the anatomical landmarks be it by inflammation, adhesions, or normal anatomical variants is worrisome due to the increased selleck chemicals llc incidence of bile duct injuries in the presence of a less than adequate exposure [39]. When comparing costs, the cost of SILS/LESS cholecystectomy was increased compared with that of LC in spite of the authors in the Bucher et al. [21] study reutilized as much material as possible. They hypothesized that the costs are a reflection of product development, and that as of now costs are not comparable to those of a routine procedure such as LC [17]. In contrast, a study by Love et al. [40] in which cost comparison between 20 patients undergoing each procedure did not yield a significant cost difference [40].

Thus the issue of comparing cost is far from over, particularly if there are still a myriad of technical options available for the realization of a SILC/LESS cholecystectomy and there is no standardized instrumentation. 4. Conclusions Current evidence suggests that even though patients prefer the cosmetic result of SILC/LESS cholecystectomy over a traditional laparoscopic approach [41], SILC/LESS cholecystectomy is still a long way off from replacing laparoscopic cholecystectomy as the gold-standard for surgical removal of the gallbladder. Insufficient evidence regarding the safety, complication rate, and costs seems to preclude the worldwide implementation of this minimally invasive procedure.

Additional concerns exist regarding patient safety if it is not a programmed surgery, thus rendering SILC/LESS cholecystectomy unavailable to a large subset of patients. Initial data showing increased complication rate along with a longer operating time, lack of standardization, and instrumentation makes SILC/LESS cholecystectomy still an experimental procedure that requires further development in order to be applicable to general surgeons worldwide. Authors’ Contribution All the authors contributed equally. Conflict of Interests The authors have no conflicting interests.
Obesity has reached epidemic levels in many countries around the world [1]. The prevalence of obesity has steadily increased over the years irrespective of demographic factors such as age, sex, race, ethnicity, or educational level [2].

It is also increasing rapidly in both industrialized and developing countries [3]. Worldwide, nearly 250 million people are obese, and the WHO has estimated that in 2025, 300 million people will be obese [4]. It is a well-known fact that obesity is associated with increased morbidity and mortality. There have been many published reports from several Caribbean nations such as Jamaica, GSK-3 Barbados, Trinidad & Tobago, and St. Lucia concerning the steady rise in the prevalence of obesity from primary school age through adolescence and adulthood [5�C8].