Low-impact laparoscopic sleeve gastrectomy: A preliminary study of feasibility, safety and early outcomes using a single-incision low-pressure pneumoperitoneum approach.

introductionPatients with severe obesity are particularly vulnerable to the physiological effects of pneumoperitoneum during laparoscopic metabolic bariatric surgery (MBS). Low-pressure laparoscopy may reduce cardiopulmonary stress and postoperative pain; however, its feasibility in MBS remains debated. This study aimed to evaluate the feasibility and early outcomes of a low-impact laparoscopic sleeve gastrectomy (LIL-SG) technique, combining single-incision access with low-pressure pneumoperitoneum in patients with severe obesity.

methodsData from consecutive patients undergoing LIL-SG were prospectively collected, analyzed and compared with a matched retrospective cohort undergoing conventional SILS-SG. Patients with BMI ≥ 50 kg/m² or complex anatomical or cardiopulmonary conditions were excluded. Pneumoperitoneum was maintained at 10-12mmHg, with temporary increases to 14mmHg permitted if necessary. Primary outcomes included intraoperative feasibility, operative parameters, and early postoperative outcomes, including pain and opioid consumption.

resultsLIL-SG was successfully completed in 36 consecutive patients without conversion, additional trocar placement, or intraoperative complications. Pneumoperitoneum ≤ 12 mmHg was maintained in 72.2% of cases; temporary increases were required in 27.8% of patients (median duration: 12 min). Median operative time was 58 min, median blood loss was 10 mL. Overall postoperative morbidity was 8.3% (minor non-surgical complications). Mortality was null. Postoperative pain scores decreased rapidly, accompanied by reduction in opioid use; no patient required opioids after discharge. Safe discharge criteria were met by postoperative day 2 in 94.4% of patients. Preliminary comparative analysis with a matched cohort of patients undergoing conventional SILS-SG demonstrated significantly lower postoperative pain scores and opioid requirements in the LIL-SG group, while length of hospital stay tended to be shorter without reaching statistical significance.

conclusionsLIL-SG combining single-incision access with low-pressure pneumoperitoneum is feasible and safe in carefully selected patients with severe obesity, offering favorable intraoperative performance, low morbidity, reduced postoperative pain, and decreased opioid requirements. Further comparative and long-term studies are warranted.