Comparison of short-term outcomes between single-incision plus one port and multi-port laparoscopic sleeve gastrectomy in patients with obesity_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

PU Yujie ^1,2 , SONG Xiaohai ^1,2 , HOU Dongsheng ^1,2 , CAO Zhan ² , YANG Shiqin ² , LI Rouli ² , DU Qiang ^1,2 , WAN Qianyi ^1,2 , ZHAO Rui ^1,2 , ZHANG Guixiang ¹ , CHENG Zhong ¹ ,  CHEN Yi ^1,2

1. Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

CHEN Yi, Email: toddy@scu.edu.cn

Keywords：

sleeve gastrectomy; single-incision plus one-port; bariatric surgery; reduced-port laparoscopic surgery; obesity

DOI：

10.7507/1007-9424.202506017

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the safety, feasibility, and efficacy of single-incision plus one-port laparoscopic sleeve gastrectomy (SILS+1) for patients with obesity. Methods A retrospective analysis was conducted on obese patients underwent laparoscopic sleeve gastrectomy (LSG) from January 2023 to November 2024 at West China Hospital of Sichuan University. Patients were stratified into two groups: SILS+1 group and conventional multi-port LSG (MPLSG) group. Comparative parameters included operative time, postoperative hospital stay, complications rate, weight loss outcomes, and improvement in metabolic indicators [including hemoglobin A1c (HbA1c), triglyceride (TG), total cholesterol (TC), and high-density lipoprotein cholesterol (HDL-C)]. Results A total of 95 patients with obesity were enrolled, including 40 in the SILS+1 group and 55 in the MPLSG group. The SILS+1 group had significantly lower preoperative body mass index (BMI), HbA1c, and TC level compared to the MPLSG group (P<0.05), and a significantly higher proportion of female patients (P<0.05). Other baseline characteristics, such as age, TG and HDL-C levels, showed no statistically significant differences (P>0.05). Operative time was significantly longer in the SILS+1 group than in the MPLSG group [(100.16±17.53) min vs. (93.82±20.83) min, P<0.001]. The proportion of patients requiring drainage tube placement was significantly lower in the SILS+1 group as compared with the MPLSG group [55.0% (22/40) vs. 76.4% (42/55), P=0.049]. There were no statistically significant differences between the two groups in the need for additional trocar sites, change in hemoglobin level from preoperative to postoperative day 1, postoperative hospital stay, or incidence of postoperative (Clavien-Dindo grade Ⅰ) complications (P>0.05). No 30-day readmissions occurred in either group. One patient in the SILS+1 group required an additional trocar site. Gastrointestinal patency was normal in all patients, with no signs of contrast agent leakage or stricture observed. Both SILS+1 and MPLSG procedures demonstrated equivalent efficacy in weight loss outcomes (P>0.05) and in their effects on HbA1c, TG, and TC levels (P>0.05). The SILS+1 procedure showed a significant advantage in improving HDL-C level (F=6.221, P=0.015), with significantly higher postoperative HDL-C level observed at 6 months postoperatively compared to the MPLSG group (F=2.500, P=0.027). Conclusions For selected obese populations, SILS+1 represents a feasible and safe alternative to MPLSG. This technique demonstrates equivalent efficacy to MPLSG in early-stage weight loss and metabolic improvement, serving as a transitional approach toward pure single-incision LSG.

Citation： PU Yujie, SONG Xiaohai, HOU Dongsheng, CAO Zhan, YANG Shiqin, LI Rouli, DU Qiang, WAN Qianyi, ZHAO Rui, ZHANG Guixiang, CHENG Zhong, CHEN Yi. Comparison of short-term outcomes between single-incision plus one port and multi-port laparoscopic sleeve gastrectomy in patients with obesity. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(9): 1114-1119. doi: 10.7507/1007-9424.202506017 Copy

1.	Brown WA, Liem R, Al-Sabah S, et al. Metabolic bariatric surgery across the IFSO chapters: key insights on the baseline patient demographics, procedure types, and mortality from the Eighth IFSO Global Registry Report. Obes Surg, 2024, 34(5): 1764-1777.
2.	Mostafa M, Bader R, Asfour G, et al. Outcomes of laparoscopic sleeve gastrectomy performed by senior surgical residents as compared to bariatric surgeons. Surg Endosc, 2025, 39(6): 3640-3647.
3.	Kang SH, Park YS, Ahn SH, et al. Laparoendoscopic single-site bariatric surgery: a review of single-port laparoscopic and endoscopic bariatric treatments. J Obes Metab Syndr, 2018, 27(1): 25-34.
4.	Lainas P, Derienne J, Dammaro C, et al. Single-port laparoscopic surgery for the treatment of severe obesity: review and perspectives. Obes Surg, 2020, 30(7): 2781-2790.
5.	Stefanopoulos A, Economopoulos KP, Kalles V. Single incision laparoscopic sleeve gastrectomy: a review. Obes Surg, 2015, 25(8): 1502-1510.
6.	García-Cabra DA, Montoya-Alvarez S, Ordorica-Flores RM, et al. Novices’ learning curve in single-port surgery using three surgical training programs. Minim Invasive Ther Allied Technol, 2024, 33(2): 90-101.
7.	Martin M, Beekley A, Kjorstad R, et al. Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis. Surg Obes Relat Dis, 2010, 6(1): 8-15.
8.	Manueli Laos EG, Martinino A, Mangano A, et al. Disparities in bariatric surgery outcomes: a regional analysis. Obes Surg, 2024, 34(10): 3848-3856.
9.	Yang J, Widjaja J, Wang R, et al. Routine gastric suspension technique in single-port sleeve gastrectomy procedure. Surg Endosc, 2023, 37(12): 9651-9657.
10.	Du GS, Jiang EL, Qiu Y, et al. Single-incision plus one-port laparoscopic gastrectomy versus conventional multi-port laparoscopy-assisted gastrectomy for gastric cancer: a retrospective study. Surg Endosc, 2022, 36(5): 3298-3307.
11.	Tranchart H, Gaillard M, Bekkhoucha S, et al. Prevention of incisional hernia after single-port sleeve gastrectomy (PRISM): a prospective non-randomized controlled study. Surg Endosc, 2022, 36(10): 7225-7232.
12.	中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和代谢病外科专家工作组. 中国肥胖及代谢疾病外科治疗指南(2024版). 中国实用外科杂志, 2024, 44(8): 841-849.
13.	Giannopoulos GA, Tzanakis NE, Rallis GE, et al. Staple line reinforcement in laparoscopic bariatric surgery: does it actually make a difference? A systematic review and meta-analysis. Surg Endosc, 2010, 24(11): 2782-2788.
14.	刘家盛, 李士军, 闫瑞承, 等. 单孔腹腔镜袖状胃切除术与传统腹腔镜袖状胃切除术的对比研究. 临床外科杂志, 2020, 28(9): 826-829.
15.	杨建军, 董文培, Wadjaja Jason, 等. 单孔腹腔镜胃袖状切除术265例临床分析. 中国实用外科杂志, 2024, 44(8): 906-910.
16.	Gaillard M, Tranchart H, Lainas P, et al. Single-port laparoscopic sleeve gastrectomy as a routine procedure in 1 000 patients. Surg Obes Relat Dis, 2016, 12(7): 1270-1277.
17.	Aboueisha MA, Freeman M, Allotey JK, et al. Battle of the buttress: 5-year propensity-matched analysis of staple-line reinforcement techniques from the MBSAQIP database. Surg Endosc, 2023, 37(4): 3090-3102.
18.	Cunningham-Hill M, Mazzei M, Zhao H, et al. The impact of staple line reinforcement utilization on bleeding and leak rates following sleeve gastrectomy for severe obesity: a propensity and case-control matched analysis. Obes Surg, 2019, 29(8): 2449-2463.
19.	Diab AF, Alfieri S, Doyle W, et al. Seamguard buttressing of the staple line during laparoscopic sleeve gastrectomy appears to decrease the incidence of postoperative bleeding, leaks, and reoperations. A systematic review and meta-analysis of non-randomized comparative studies. Obes Surg, 2023, 33(7): 2237-2245.
20.	Kang SH, Hwang D, Yoo M, et al. Feasibility of articulating laparoscopic instruments in laparoscopic gastrectomy using propensity score matching. Sci Rep, 2023, 13(1): 17384. doi: 10.1038/s41598-023-44305-1.
21.	Ataya K, Bsat AM, Aljaafreh A, et al. Single incision versus conventional multiport laparoscopic sleeve gastrectomy: meta-analysis and systematic review. Cureus, 2023, 15(10): e46956. doi: 10.7759/cureus.46956.
22.	D’Ugo S, Bellato V, Bianciardi E, et al. Impact of resected gastric volume on postoperative weight loss after laparoscopic sleeve gastrectomy. Gastroenterol Res Pract, 2019, 2019: 3742075. doi: 10.1155/2019/3742075.
23.	Zhao S, Fu Y, Zhou J, et al. Comparing the efficacy of robotic versus laparoscopic sleeve gastrectomy: a systematic review and meta-analysis. Obes Surg, 2024, 34(9): 3493-3505.
24.	Tartaglia N, Pavone G, Germano MP, et al. Relationship between residual gastric area and weight loss after sleeve gastrectomy: a cohort study. Ann Med Surg (Lond), 2021, 73: 103177. doi: 10.1016/j.amsu.2021.103177.
25.	Mohamedahmed AYY, Hamid M, Zaman S, et al. Does omentopexy make a difference in laparoscopic sleeve gastrectomy for obesity treatment? A systematic review and meta-analysis. Obes Surg, 2024, 34(1): 218-235.
26.	Morgantini LA, Alzein A, Bharadwaj A, et al. A prospective study on single-port versus multiport patient-reported surgical outcomes. BJUI Compass, 2023, 5(1): 84-89.
27.	Liu ZM, Yao QJ, Pei F, et al. Efficacy and safety of reduced-port laparoscopic surgery versus conventional laparoscopic surgery for colorectal cancer. BMC Cancer, 2025, 25(1): 187. doi: 10.1186/s12885-025-13585-3.
28.	Zarzycki P, Kulawik J, Małczak P, et al. Laparoscopic sleeve gastrectomy with omentopexy: is it really a promising method?—a systematic review with meta-analysis. Obes Surg, 2021, 31(6): 2709-2716.

1. Brown WA, Liem R, Al-Sabah S, et al. Metabolic bariatric surgery across the IFSO chapters: key insights on the baseline patient demographics, procedure types, and mortality from the Eighth IFSO Global Registry Report. Obes Surg, 2024, 34(5): 1764-1777.
2. Mostafa M, Bader R, Asfour G, et al. Outcomes of laparoscopic sleeve gastrectomy performed by senior surgical residents as compared to bariatric surgeons. Surg Endosc, 2025, 39(6): 3640-3647.
3. Kang SH, Park YS, Ahn SH, et al. Laparoendoscopic single-site bariatric surgery: a review of single-port laparoscopic and endoscopic bariatric treatments. J Obes Metab Syndr, 2018, 27(1): 25-34.
4. Lainas P, Derienne J, Dammaro C, et al. Single-port laparoscopic surgery for the treatment of severe obesity: review and perspectives. Obes Surg, 2020, 30(7): 2781-2790.
5. Stefanopoulos A, Economopoulos KP, Kalles V. Single incision laparoscopic sleeve gastrectomy: a review. Obes Surg, 2015, 25(8): 1502-1510.
6. García-Cabra DA, Montoya-Alvarez S, Ordorica-Flores RM, et al. Novices’ learning curve in single-port surgery using three surgical training programs. Minim Invasive Ther Allied Technol, 2024, 33(2): 90-101.
7. Martin M, Beekley A, Kjorstad R, et al. Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis. Surg Obes Relat Dis, 2010, 6(1): 8-15.
8. Manueli Laos EG, Martinino A, Mangano A, et al. Disparities in bariatric surgery outcomes: a regional analysis. Obes Surg, 2024, 34(10): 3848-3856.
9. Yang J, Widjaja J, Wang R, et al. Routine gastric suspension technique in single-port sleeve gastrectomy procedure. Surg Endosc, 2023, 37(12): 9651-9657.
10. Du GS, Jiang EL, Qiu Y, et al. Single-incision plus one-port laparoscopic gastrectomy versus conventional multi-port laparoscopy-assisted gastrectomy for gastric cancer: a retrospective study. Surg Endosc, 2022, 36(5): 3298-3307.
11. Tranchart H, Gaillard M, Bekkhoucha S, et al. Prevention of incisional hernia after single-port sleeve gastrectomy (PRISM): a prospective non-randomized controlled study. Surg Endosc, 2022, 36(10): 7225-7232.
12. 中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和代谢病外科专家工作组. 中国肥胖及代谢疾病外科治疗指南(2024版). 中国实用外科杂志, 2024, 44(8): 841-849.
13. Giannopoulos GA, Tzanakis NE, Rallis GE, et al. Staple line reinforcement in laparoscopic bariatric surgery: does it actually make a difference? A systematic review and meta-analysis. Surg Endosc, 2010, 24(11): 2782-2788.
14. 刘家盛, 李士军, 闫瑞承, 等. 单孔腹腔镜袖状胃切除术与传统腹腔镜袖状胃切除术的对比研究. 临床外科杂志, 2020, 28(9): 826-829.
15. 杨建军, 董文培, Wadjaja Jason, 等. 单孔腹腔镜胃袖状切除术265例临床分析. 中国实用外科杂志, 2024, 44(8): 906-910.
16. Gaillard M, Tranchart H, Lainas P, et al. Single-port laparoscopic sleeve gastrectomy as a routine procedure in 1 000 patients. Surg Obes Relat Dis, 2016, 12(7): 1270-1277.
17. Aboueisha MA, Freeman M, Allotey JK, et al. Battle of the buttress: 5-year propensity-matched analysis of staple-line reinforcement techniques from the MBSAQIP database. Surg Endosc, 2023, 37(4): 3090-3102.
18. Cunningham-Hill M, Mazzei M, Zhao H, et al. The impact of staple line reinforcement utilization on bleeding and leak rates following sleeve gastrectomy for severe obesity: a propensity and case-control matched analysis. Obes Surg, 2019, 29(8): 2449-2463.
19. Diab AF, Alfieri S, Doyle W, et al. Seamguard buttressing of the staple line during laparoscopic sleeve gastrectomy appears to decrease the incidence of postoperative bleeding, leaks, and reoperations. A systematic review and meta-analysis of non-randomized comparative studies. Obes Surg, 2023, 33(7): 2237-2245.
20. Kang SH, Hwang D, Yoo M, et al. Feasibility of articulating laparoscopic instruments in laparoscopic gastrectomy using propensity score matching. Sci Rep, 2023, 13(1): 17384. doi: 10.1038/s41598-023-44305-1.
21. Ataya K, Bsat AM, Aljaafreh A, et al. Single incision versus conventional multiport laparoscopic sleeve gastrectomy: meta-analysis and systematic review. Cureus, 2023, 15(10): e46956. doi: 10.7759/cureus.46956.
22. D’Ugo S, Bellato V, Bianciardi E, et al. Impact of resected gastric volume on postoperative weight loss after laparoscopic sleeve gastrectomy. Gastroenterol Res Pract, 2019, 2019: 3742075. doi: 10.1155/2019/3742075.
23. Zhao S, Fu Y, Zhou J, et al. Comparing the efficacy of robotic versus laparoscopic sleeve gastrectomy: a systematic review and meta-analysis. Obes Surg, 2024, 34(9): 3493-3505.
24. Tartaglia N, Pavone G, Germano MP, et al. Relationship between residual gastric area and weight loss after sleeve gastrectomy: a cohort study. Ann Med Surg (Lond), 2021, 73: 103177. doi: 10.1016/j.amsu.2021.103177.
25. Mohamedahmed AYY, Hamid M, Zaman S, et al. Does omentopexy make a difference in laparoscopic sleeve gastrectomy for obesity treatment? A systematic review and meta-analysis. Obes Surg, 2024, 34(1): 218-235.
26. Morgantini LA, Alzein A, Bharadwaj A, et al. A prospective study on single-port versus multiport patient-reported surgical outcomes. BJUI Compass, 2023, 5(1): 84-89.
27. Liu ZM, Yao QJ, Pei F, et al. Efficacy and safety of reduced-port laparoscopic surgery versus conventional laparoscopic surgery for colorectal cancer. BMC Cancer, 2025, 25(1): 187. doi: 10.1186/s12885-025-13585-3.
28. Zarzycki P, Kulawik J, Małczak P, et al. Laparoscopic sleeve gastrectomy with omentopexy: is it really a promising method?—a systematic review with meta-analysis. Obes Surg, 2021, 31(6): 2709-2716.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of short-term outcomes between single-incision plus one port and multi-port laparoscopic sleeve gastrectomy in patients with obesity

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content