Single-port laparoscopic sleeve gastrectomy (SILSG) is a viable alternative procedure to multiport conventional sleeve gastrectomy (CLSG) with comparable outcomes and better cosmetic satisfaction scores, according to the outcomes of a meta-analysis and systematic review by researchers from King's College Hospital, London, and the American University of Beirut Medical Center, Beirut, Lebanon. The findings were featured in the paper, ‘Single Incision Versus Conventional Multiport Laparoscopic Sleeve Gastrectomy: Meta-Analysis and Systematic Review’, published in Cureus.
This study included 14 studies, comprising 1,560 patients in the multiport group and 1,554 patients in the single-port group. These studies were published between 2010 and 2022 and originated from various countries, including the US, Italy, France, Japan, Egypt, India, Qatar, Spain, Iran and Austria. The researchers sought to report on operative time, excess weight loss, intraoperative bleeding, postoperative leak, incisional hernia rates, length of hospital stay, postoperative complications and cosmetic scores.
They reported that the average body mass index (BMI) was 40 for the multiport group and 42.2 for the single-port group. The mean operative time ranged from 42 to 170 min in the multiport group and from 45 to 148.7 min in the single-port group with no statistically significant difference between the two procedures (p=0.2). From the 14 studies included, ten discussed the length of hospital stay, involving a total of 1,174 patients in the multiport group and 1,157 in the single-port group. The mean length of hospital stay was comparable for both groups ranging from 1.75 to six days in the multiport group and from 1.7 to five days in the single-port group (p=0.24).
Postoperative leaks were examined in six studies and there were 20 incidents in the single-port group and ten in the multiport group, resulting in leak rates of 1.28% and 0.6% for patients who underwent single-port and multiport LSG, respectively (p=0.21).
Intraoperative bleeding was almost equally distributed between the multiport and single-port groups, with 23 incidents in the single-port group vs. 22 in the multiport group (p=0.9). Surgical site infections occurred at nearly the same rate in both the multiport and single-port LSG groups (p=0.96). Incisional hernias occurred in 13 cases in the single-port group compared with 10 cases in the multiport group (p=0.93).
At six months post-operation, 12 studies showed the mean percentage of excess weight loss was 43.9% in the multiport group and 49.01% in the single-port group (p=0.33). Gastroesophageal reflux disorder was reported in only three articles reporting 18 cases in both the single-port and multiport groups, (p=0.98). Two studies that assessed the cosmetic satisfaction score reported a mean difference of 1.45, indicating superior cosmetic results in the single-incision group (p>0.00001 and p=0.008).
“The findings of this systematic review indicate that SILSG is technically feasible and increasingly practiced internationally. It appears to yield clinical outcomes comparable to those of conventional multiport sleeve gastrectomy. While we caution against drawing definitive conclusions from this study, we believe there is a viable future for single-incision laparoscopic surgery as more data emerge on its safety and feasibility. We recommend further randomised controlled trials, stronger control groups, reduced heterogeneity, and extended follow-up periods to better evaluate the safety and long-term outcomes of this procedure.”
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