Application of single-port laparoscopic sleeve gastrectomy in a Chinese patient with a BMI of 86.4 kg/m²: a case report

Published experience with single-port laparoscopic sleeve gastrectomy (SPSG) in Asian patients with a body mass index (BMI) exceeding 80 kg/m² is extremely limited. We report a 43-year-old Chinese man with a BMI of 86.4 kg/m² and severe cardiopulmonary and obesity-related comorbidities. A multidisciplinary team undertook intensive cardiopulmonary, anesthetic, endocrine, and nutritional optimization. Preoperative medical weight management included tirzepatide, a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist. Gastric retention identified after the treatment period raised concern regarding delayed gastric emptying and aspiration risk; a liquid diet was prescribed, and bedside gastric ultrasonography on the day of surgery did not identify apparent residual gastric contents. SPSG was completed using low-pressure pneumoperitoneum and a gastric suspension technique. Operative time was 65 min and estimated blood loss was 20 mL. No intraoperative or reported early postoperative complications occurred, and the patient was discharged within one week. At approximately five months after surgery, his body weight had decreased by 55 kg from baseline, his sacrococcygeal pressure sores had healed, and his apnea-hypopnea index decreased from 61.8 to 21.2 events/h. This highly selected case illustrates the short-term technical feasibility of SPSG after intensive multidisciplinary optimization by an experienced bariatric team. It should not be interpreted as evidence supporting routine SPSG in patients with extreme obesity; long-term safety, weight-loss durability, reflux outcomes, comorbidity response, and the potential need for revisional surgery remain unknown.