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Introduction <p>Patients 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.</p> Methods <p>Data 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&#xa0;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.</p> Results <p>LIL-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&#xa0;min). Median operative time was 58&#xa0;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.</p> Conclusions <p>LIL-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.</p>

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

  • 期刊论文

  • 发表日期：

    2026年6月16日

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  • Panagiotis Lainas,
  • Ioannis Paschopoulos,
  • Carmelisa Dammaro,
  • Styliani Zervaki,
  • Minavera Mersini,
  • Niaz Devaquet,
  • Ibrahim Dagher

摘要

Introduction

Patients 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.

Methods

Data 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.

Results

LIL-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.

Conclusions

LIL-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.