Single-incision laparoscopic sleeve gastrectomy with a focus on class I obesity: a single-centre cohort study with long-term follow-up

Single-incision laparoscopic sleeve gastrectomy (SILS-SG) achieves the same gastric resection as conventional multi-port laparoscopic sleeve gastrectomy (LSG) through a single umbilical incision. Published single-incision series have been performed almost exclusively in severe obesity, while sleeve gastrectomy series in class I obesity (body mass index [BMI] 30.0–34.9 kg/m²) have used conventional multi-port access. We evaluated the feasibility, safety, weight-loss durability and revisional surgery rate of SILS-SG in a consecutive single-centre cohort in which class I obesity was the predominant indication. Retrospective cohort study of 272 consecutive patients who underwent SILS-SG at a specialised bariatric centre in Belgium between January 2012 and December 2022, including a prespecified subcohort of 225 patients with class I obesity. Outcomes were percentage total weight loss (%TWL); percentage excess body-weight loss (%EBWL, relative to an ideal BMI of 22.5 kg/m²); achievement of a BMI of 20–25 kg/m² at last follow-up; complications graded by the Clavien-Dindo classification; 30-day readmission; freedom from revisional surgery, estimated by the Kaplan-Meier method; and 30- and 90-day mortality. Denominators are reported for every outcome. Mean age was 33.8 ± 10.5 years, mean preoperative BMI 31.7 ± 2.1 kg/m² and mean weight 87.1 ± 8.3 kg; 265 patients (97.4%) were women and 225 (82.7%) had class I obesity. Five patients (1.8%) had a 30-day complication: two Clavien-Dindo grade I events, two grade IIIa events (a staple-line leak managed by percutaneous drainage and a gastric obstruction managed by endoscopic dilation) and one grade IIIb event (haemorrhage requiring re-exploration). Six patients (2.2%) were readmitted within 30 days and there was no 30- or 90-day mortality. Median follow-up was 35 months. Among the 188 patients (69.1%) with a documented final weight, mean %TWL was 20.2 ± 10.8%, mean %EBWL 70.7 ± 36.7% and mean final BMI 25.3 ± 3.4 kg/m²; 90 of 188 (47.9%) reached a BMI of 20–25 kg/m². These weight-loss estimates are derived from patients with documented follow-up and are probably favourably biased. Eighteen patients (6.6%) underwent revisional surgery, most often conversion to Roux-en-Y gastric bypass (RYGB; 13 patients, for weight regain in eight, reflux in four and both in one) at a median of 48 months. Kaplan-Meier freedom from revisional surgery was 98.6% (95% CI 94.7–99.7) at 12 months and 89.2% (95% CI 81.1–94.0) at 48 months (class I subcohort: 99.1% and 91.2%). In this highly selected, predominantly young and female cohort, SILS-SG was feasible, was performed with a low complication rate and no mortality, and was followed by durable, clinically meaningful weight loss among patients with documented follow-up. In the absence of a contemporaneous multi-port comparison group, these single-arm data cannot establish the relative merits of SILS-SG over conventional LSG; they indicate that SILS-SG is a feasible option in appropriately selected patients with class I obesity and provide a basis for prospective comparative studies.