Abstract Background Single-port sleeve gastrectomy offers cosmetic and recovery advantages, but its technical demands and instrumentation limitations can be a barrier to widespread adoption, particularly in resource-constrained settings or among surgeons early in their learning curve. The single-port plus one (SP + 1) technique has been proposed as an intermediary approach that adds a secondary working trocar to facilitate safer dissection and stapling, while preserving the minimally invasive, aesthetic benefits of single-port access. This study aimed to assess the short-term outcomes and safety profile of SP + 1 sleeve gastrectomy in comparison to conventional multi-port sleeve gastrectomy (MPSG). Methods We conducted a retrospective analysis of patients who underwent laparoscopic sleeve gastrectomy performed by a single experienced bariatric surgeon between January 2023 and March 2024. Patients were grouped according to surgical approach: SP + 1 or MPSG. Baseline characteristics, intraoperative data, perioperative complications, and postoperative outcomes—including percentage of total weight loss (%TWL) at 3 and 6 months—were recorded. Complications were graded using the Clavien-Dindo classification. All patients received standard postoperative nutritional and lifestyle support. Results A total of 95 patients were included (SP + 1: n = 40; MPSG: n = 55). Patients in the SP + 1 group had significantly lower baseline BMI (33.62 ± 3.94 versus 36.47 ± 4.25 kg/m2, P = 0.001) and body weight (88.87 ± 12.01 versus 102.92 ± 15.88 kg, P 0.001), likely reflecting a preference to initiate the SP + 1 approach in lower-risk individuals. Operative time was comparable between groups (100.2 ± 17.5 versus 93.8 ± 20.8 min, P = 0.12). No intraoperative complications occurred, and no patients required conversion to multi-port or open surgery. The 30-day complication rate was low in both groups, with only minor complications (Clavien-Dindo Grade I) observed. No readmissions were recorded. At 3 months postoperatively, %TWL was 18.3% in the SP + 1 group and 19.8% in the MPSG group (P = 0.14). At 6 months, the respective %TWL values were 23.1% versus 25.6% (P = 0.09), indicating no statistically significant difference in short-term weight loss outcomes. Early metabolic improvements, including reductions in fasting glucose and triglyceride levels, were similar between groups. Conclusion The SP + 1 technique is a safe and feasible alternative to conventional multi-port sleeve gastrectomy when applied to appropriately selected patients. It maintains comparable early outcomes in terms of weight loss and metabolic improvements, while offering potential ergonomic and cosmetic benefits. Moreover, SP + 1 serves as a practical transitional technique for surgeons aiming to progress toward full single-port bariatric surgery, particularly in training environments or settings with limited access to specialized single-port instruments. Further studies with larger sample sizes and longer follow-up are warranted to validate these findings and assess long-term outcomes.
Chen et al. (2026) studied this question.