Laparoscopic sleeve gastrectomy (LSG) is one of the most frequently performed procedures in metabolic and bariatric surgery. Single-port sleeve gastrectomy (SPSG/SILSG) and reduced-port LSG (RPLSG) have re-emerged as attempts to refine minimally invasive access rather than to change the metabolic operation itself. Evidence published from 2019 to 2026 suggests that, in experienced centers and carefully selected patients, single-port and reduced-port LSG can be performed safely, with short-term morbidity and weight-loss outcomes broadly comparable to conventional multiport LSG. The main potential advantages are fewer visible incisions, more concealed scars, and higher cosmetic satisfaction. However, transumbilical single-port access concentrates fascial stress in one incision and may worsen instrument triangulation, fundal exposure, specimen extraction, and fascial closure. Long-term risks, especially trocar-site hernia and gastroesophageal reflux disease (GERD), remain insufficiently reported. The value of single-port or reduced-port LSG therefore lies not in port reduction alone, but in delivering a perceptible and reproducible patient benefit without compromising the standardized safety principles of LSG. Future studies should move beyond technical feasibility and focus on patient selection, standardized port-site reporting, long-term abdominal wall and esophageal safety, and patient-reported outcomes.
References
[1]
Eisenberg, D., Shikora, S.A., Aarts, E., Aminian, A., Angrisani, L., Cohen, R.V., et al. (2023) 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obesity Surgery, 33, 3-14. https://doi.org/10.1007/s11695-022-06332-1
[2]
De Luca, M., Shikora, S., Eisenberg, D., Angrisani, L., Parmar, C., Alqahtani, A., et al. (2024) Scientific Evidence for the Updated Guidelines on Indications for Metabolic and Bariatric Surgery (IFSO/ASMBS). Obesity Surgery, 34, 3963-4096. https://doi.org/10.1007/s11695-024-07370-7
[3]
Gutiérrez-Ramírez, L., Morandeira-Rivas, A., Medina-Benítez, E., Arias-Arias, á. and Moreno-Sanz, C. (2024) Reduced Port Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-Analysis. Obesity Surgery, 34, 4519-4530. https://doi.org/10.1007/s11695-024-07555-0
[4]
Jiang, Z., Zhang, Z., Feng, T., Cheng, Y., Zhang, G., Zhong, M., et al. (2023) Trocar Number and Placement for Laparoscopic Sleeve Gastrectomy and Comparison of Single-Incision and Conventional Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-Analysis. International Journal of Surgery, 109, 1783-1795. https://doi.org/10.1097/js9.0000000000000402
[5]
Ataya, K., Bsat, A.M., Aljaafreh, A., Al Ayoubi, A.R. and Al Tannir, A.H. (2023) Single Incision versus Conventional Multiport Laparoscopic Sleeve Gastrectomy: Meta-Analysis and Systematic Review. Cureus, 15, e46956. https://doi.org/10.7759/cureus.46956
[6]
Tranchart, H., Rebibo, L., Gaillard, M., Dhahri, A., Lainas, P., Regimbeau, J., et al. (2020) Short-Term Outcomes of Single-Port versus Conventional Laparoscopic Sleeve Gastrectomy: A Propensity Score Matched Analysis. Surgical Endoscopy, 34, 3978-3985. https://doi.org/10.1007/s00464-019-07175-1
[7]
Khidir, N., Gagner, M., El Matbouly, M., El Ansari, W., Billy, H., Karam, M., et al. (2020) Single-Port Sleeve Gastrectomy Compared with Conventional Laparoscopic Sleeve Gastrectomy: 5-Year Follow-Up of Weight Loss, Comorbidity Resolution, and Cost. Surgical Innovation, 27, 265-271. https://doi.org/10.1177/1553350620902550
[8]
Wang, L., Zheng, X., Sang, Q., Du, D., Lian, D. and Zhang, N. (2020) Single-Incision Transumbilical Laparoscopic Sleeve Gastrectomy with a Stomach Retractor in 20 Superobese Patients—A Video Vignette. Obesity Surgery, 30, 5179-5181. https://doi.org/10.1007/s11695-020-04995-2
[9]
Borjas, G., Sánchez, N., Urdaneta, A., Maldonado, A. and Ramos, E. (2023) Magnetic-Assisted Reduced-Port Sleeve Gastrectomy versus Laparoscopic Sleeve Gastrectomy: A Comparative Study. Obesity Surgery, 33, 2261-2265. https://doi.org/10.1007/s11695-023-06628-w
[10]
Abdallah, H., Derienne, J., Courie, R., Voican, C.S., Perlemuter, G., Donatelli, G., et al. (2025) Single-Port Sleeve Gastrectomy: A Comparison between Transumbilical and Left Hypochondrium Approaches. Surgical Endoscopy, 39, 2221-2227. https://doi.org/10.1007/s00464-025-11529-3
[11]
Widjaja, J., Meng, X., Sun, H. and Lin, H. (2025) Outcomes and Challenges of Transumbilical Single-Port Sleeve Gastrectomy: A Retrospective Analysis Based on Height and BMI. Obesity Surgery, 35, 837-842. https://doi.org/10.1007/s11695-024-07638-y
[12]
Zidan, M.H., El-Masry, H., Amgad, A., Altabbaa, H., Abdou, M.E., Amer, S.A., et al. (2025) Port Site Placement and Outcomes for Surgical Obesity and Metabolic Surgeries (PSPOSO) Checklist: A New Reporting Checklist Based on Evidential Assessment of the Number of Trocars and Positions. Obesity Surgery, 35, 1086-1108. https://doi.org/10.1007/s11695-025-07694-y
[13]
Iossa, A., Martini, L., De Angelis, F., Micalizzi, A., Watkins, B.M., Silecchia, G., et al. (2024) Leaks after Laparoscopic Sleeve Gastrectomy: 2024 Update on Risk Factors. Langenbeck’s Archives of Surgery, 409, Article No. 249. https://doi.org/10.1007/s00423-024-03424-7
[14]
Ma, L., Gao, Z., Luo, H., Kou, S., Lei, Y., Jia, V., et al. (2024) Comparison of the Postoperative Outcome with and without Intraoperative Leak Testing for Sleeve Gastrectomy: A Systematic Review and Meta-Analysis of 469 588 Cases. International Journal of Surgery, 110, 1196-1205. https://doi.org/10.1097/js9.0000000000000919
[15]
Elshawy, M., Albalkiny, S., Helmy, R., Jaradat, D., Omar, A.S.M., Salama, M.M., et al. (2025) Three-Port Bikini Line vs. Conventional Sleeve Gastrectomy: A Prospective Cohort Study on Safety, Efficacy, and Aesthetic Outcomes. Obesity Surgery, 35, 5038-5046. https://doi.org/10.1007/s11695-025-08273-x
[16]
Bilecik, T., Ta？k？n, H.E. and Habibi, M. (2026) Comparison of Early Results of Aesthetic Focused Bikini-Line Sleeve Gastrectomy and Standard Laparoscopic Sleeve Gastrectomy. Obesity Surgery, 36, 628-638. https://doi.org/10.1007/s11695-025-08448-6
[17]
Mu？oz-Leija, M.A., Rosales-Pérez, G. and álvarez-Valdés, G. (2026) Early and Late Trocar-Site Outcomes after Laparoscopic Sleeve Gastrectomy Using a Standardized Fascial Closure Technique: A Prospective Observational Study. Obesity Surgery, 36, 2204-2210. https://doi.org/10.1007/s11695-026-08585-6
[18]
Xu, Z., Zhang, W., Chen, S., Liu, B. and Sun, Y. (2025) Analysis of Predictive Factors for the Efficacy of Modified Three-Port Laparoscopic Sleeve Gastrectomy in Treating Type 2 Diabetes Mellitus. Diabetes, Metabolic Syndrome and Obesity, 18, 3375-3385. https://doi.org/10.2147/dmso.s525774
[19]
Niu, C., Li, B., Wan, H., Jin, W., Zhang, Z., Zhang, W., et al. (2025) Antrum Preservation versus Antrum Resection in Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of Investigative Surgery, 38, Article 2477099. https://doi.org/10.1080/08941939.2025.2477099
[20]
Chaouch, M.A., Khalfallah, M., Jabra, S.B., Jouilli, M., Sallem, O.K., Nouira, R., et al. (2024) Omentopexy versus No Omentopexy in Sleeve Gastrectomy: An Updated Systematic Review and Meta-Analysis. Updates in Surgery, 76, 811-827. https://doi.org/10.1007/s13304-024-01794-7
[21]
Al-Juhani, A., Sharaf, G.F., Alyaseen, E.M., Alkurdi, A., Azhari, A.S., Alshaiban, S.H., et al. (2024) Banded versus Non-Banded Sleeve Gastrectomy: A Systematic Review and Meta-Analysis. Cureus, 16, e52799. https://doi.org/10.7759/cureus.52799
[22]
Znamirowski, P., Ko？omańska, M., Mazurkiewicz, R., Tymchyshyn, O. and Nawacki, ？. (2023) GERD as a Complication of Laparoscopic Sleeve Gastrectomy for the Treatment of Obesity: A Systematic Review and Meta-Analysis. Journal of Personalized Medicine, 13, Article 1243. https://doi.org/10.3390/jpm13081243
[23]
Chandan, S., Khan, S.R., Deliwala, S.S., Dahiya, D.S., Mohan, B.P., Ramai, D., et al. (2025) Risk of De Novo Barrett’s Esophagus Post Sleeve Gastrectomy: A Systematic Review and Meta-Analysis of Studies with Long-Term Follow-Up. Clinical Gastroenterology and Hepatology, 23, 33-44.E10. https://doi.org/10.1016/j.cgh.2024.06.041
[24]
Cammarata, F., Novia, M., Aiolfi, A., Damiani, R., Manara, M., Giovanelli, A., et al. (2024) Magnetic Sphincter Augmentation for Gastroesophageal Reflux after Sleeve Gastrectomy: A Systematic Review. Obesity Surgery, 34, 4232-4243. https://doi.org/10.1007/s11695-024-07523-8
[25]
Park, Y., Park, Y.S., Lee, S., Kang, S.H., Lee, E., Ahn, S., et al. (2021) Safety and Effectiveness of Reduced-Port Laparoscopic Sleeve Gastrectomy in Asian Morbidly Obese Patients. Scientific Reports, 11, Article No. 23511. https://doi.org/10.1038/s41598-021-02999-1
[26]
Lainas, P., Derienne, J., Zervaki, S., Del Basso, C., Malerba, V., Devaquet, N., et al. (2021) Left Hypochondrium or Transumbilical Single-Incision Laparoscopic Sleeve Gastrectomy for the Treatment of Severe Obesity: Surgical Technique and Results of a Tertiary Referral Bariatric Center. Obesity Surgery, 31, 5063-5070. https://doi.org/10.1007/s11695-021-05563-y
[27]
Lainas, P., Derienne, J., Dammaro, C., Schoucair, N., Devaquet, N. and Dagher, I. (2020) Single-Port Laparoscopic Surgery for the Treatment of Severe Obesity: Review and Perspectives. Obesity Surgery, 30, 2781-2790. https://doi.org/10.1007/s11695-020-04620-2
[28]
Zhao, S., Fu, Y., Zhou, J., Sun, L., Li, R., Tian, Z., et al. (2024) Comparing the Efficacy of Robotic versus Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-Analysis. Obesity Surgery, 34, 3493-3505. https://doi.org/10.1007/s11695-024-07413-z
[29]
Giambavicchio, L.L., Matarangolo, A., Santi, H.T., Corvasce, A. and Braun, A. (2025) Left-Sided Sleeve Gastrectomy (LS-SG): A Safe and Efficient Approach to Bariatric Surgery. Obesity Surgery, 35, 5023-5027. https://doi.org/10.1007/s11695-025-08328-z
[30]
Monteiro Delgado, L., Fabretina de Souza, V., Fontel Pompeu, B., de Moraes Ogawa, T., Pereira Oliveira, H., Sacksida Vallad？o, V.D.C., et al. (2025) Long-Term Outcomes in Sleeve Gastrectomy versus Roux-en-Y Gastric Bypass: A Systematic Review and Meta-Analysis of Randomized Trials. Obesity Surgery, 35, 3246-3257. https://doi.org/10.1007/s11695-025-08044-8
[31]
Mechanick, J.I., Apovian, C., Brethauer, S., Garvey, W.T., Joffe, A.M., Kim, J., et al. (2019) Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures—2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Endocrine Practice, 25, 1-75. https://doi.org/10.4158/gl-2019-0406
