Single-Incision versus Conventional Laparoscopic Sleeve Gastrectomy: Superior Long-Term Weight Maintenance in a 7-Year Matched Cohort Study

Background Long-term weight regain affects 20%-30% of patients after laparoscopic sleeve gastrectomy (LSG). We investigated whether single-incision laparoscopic sleeve gastrectomy (SILS) provides superior weight maintenance compared to conventional multi-port LSG. Methods This study is a retrospective analysis of prospectively collected data comparing 54 propensity-matched patients (27 SILS and 27 conventional LSG) operated between 2010 and 2017. Primary outcome was weight maintenance at 7 years. Secondary outcomes included safety profile, complications, quality of life, and patient satisfaction. Results Groups were comparable except baseline BMI (SILS: 40.17 ± 3.23 vs conventional: 43.71 ± 5.36 kg/m 2 , P = .005). Single-incision laparoscopic sleeve gastrectomy demonstrated safety non-inferiority with no conversions, leaks, or reoperations in either group. Overall complications: 11.1% SILS vs 3.7% conventional ( P = .308). At 7 years, SILS patients maintained significantly lower absolute weight (75.56 ± 13.24 vs 85.26 ± 19.78 kg, P = .039) despite similar %EWL (85.2% vs 92.6%, P = .396). Weight regain from nadir was 11.26 ± 9.24 vs 15.04 ± 14.10 kg ( P = .250). Enhanced patient satisfaction scores in SILS (9.56 ± 0.93 vs 8.07 ± 1.90, P = 0.001) suggest a potential mediating mechanism. Conclusions Single-incision laparoscopic sleeve gastrectomy achieves superior long-term weight maintenance while demonstrating safety non-inferiority compared to conventional LSG. The technique resulted in 10 kg lower absolute weight at 7 years without increased complications. For appropriately selected patients, SILS offers a safe alternative with improved long-term metabolic outcomes.