Single Incision Versus Conventional Multiport Laparoscopic Sleeve Gastrectomy: Meta-Analysis and Systematic Review

Abstract

Laparoscopic sleeve gastrectomy (LSG) is the most widely performed bariatric surgery and has been associated with excellent outcomes and a significant reduction in obesity-related morbidity and mortality. Traditionally, this surgery is performed using five to seven trocars. However, LSG performed through a single trocar is emerging as a less invasive method of performing this surgery. This systematic review and meta-analysis compare the outcomes and complication rates of single-port versus multi-port LSG. We searched PubMed, Medline, Scopus, and the Cochrane Library for articles published from 2008 to 2023, in accordance with the PRISMA 2020 guidelines. Data on variables such as operative time, excess weight loss, intraoperative bleeding, postoperative leak, and incisional hernia rates were collected and analyzed using a random-effects model. Fourteen articles met the inclusion criteria and were included in the meta-analysis. No significant differences were found between the single-port LSG (SILSG) and conventional LSG (CLSG) groups in terms of operative time, rate, intraoperative complications, length of hospital stay, postoperative complications, and excess weight loss (EWL). Furthermore, single incision sleeve gastrectomy showed better satisfaction with the cosmetic score. SILSG is a viable alternative procedure, showing comparable outcomes to multiport conventional sleeve gastrectomy, in addition, to a better cosmetic satisfaction score.

Keywords: bariatric surgery; laparoscopic surgery; multiport; single-incision; sleeve gastrectomy.

Figure 1. PRISMA 2020 Flow Diagram for Systematic Reviews

Figure 2. Mean Operative Time

Gomberawalla et al. [7], Lakdawala et al. [4], Saber et al. [15], Porta et al. [8], Muir et al. [13], Mauriello et al. [9], Tranchart et al. [5], Amiki et al. [10], Alkashty et al. [11], Lakdawala et al. [12], Khidir et al. [14], Sucher et al. [18], Delgado et al. [16], Hosseini et al. [17]

Figure 3. Length of Hospital Stay

Gomberawalla et al. [7], Saber et al. [15], Porta et al. [8], Mauriello et al. [9], Tranchart et al. [5], Amiki et al. [10], Alkashty et al. [11], Khidir et al. [14], Sucher et al. [18], Hosseini et al. [17].

Figure 4. Post-op Leak

Gomberawalla et al. [7], Lakdawala et al. [4], Saber et al. [15], Porta et al. [8], Muir et al. [13], Mauriello et al. [9], Tranchart et al. [5], Amiki et al. [10], Alkashty et al. [11], Lakdawala et al. [12], Khidir et al. [14], Sucher et al. [18], Delgado et al. [16], Hosseini et al. [17]

Figure 5. Bleeding

Gomberawalla et al. [7], Lakdawala et al. [4], Saber et al. [15], Porta et al. [8], Muir et al. [13], Mauriello et al. [9], Tranchart et al. [5], Amiki et al. [10], Alkashty et al. [11], Khidir et al. [14], Sucher et al. [18], Hosseini et al. [17]

Figure 6. Surgical Site Infection

Lakdawala et al. [4], Saber et al. [15], Porta et al. [8], Muir et al. [13], Mauriello et al. [9], Amiki et al. [10], Alkashty et al. [11], Lakdawala et al. [12], Khidir et al. [14], Delgado et al. [16], Hosseini et al. [17]

Figure 7. Incisional Hernia

Gomberawalla et al. [7], Saber et al. [15], Porta et al. [8], Muir et al. [13], Mauriello et al. [9], Tranchart et al. [5], Alkashty et al. [11], Lakdawala et al. [12], Khidir et al. [14], Sucher et al. [18], Delgado et al. [16], Hosseini et al. [17]

Figure 8. Excess Weight Loss at 6 Months

Gomberawalla et al. [7], Lakdawala et al. [4], Saber et al. [15], Porta et al. [8], Muir et al. [13], Mauriello et al. [9], Tranchart et al. [5], Alkashty et al. [11], Lakdawala et al. [12], Sucher et al. [18], Delgado et al. [16], Hosseini et al. [17]

Figure 9. Cosmetic Satisfaction Score

Porta et al. [8], Sucher et al. [18]

Figure 10. Gastroesophageal Reflux Disorder

Amiki et al. [10], Lakdawala et al. [12], Sucher et al. [18]