Clinical Progress in Single-Port and Reduced-Port Laparoscopic Sleeve Gastrectomy

Abstract

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.