This study aimed to compare the differences between single-port laparoscopic sleeve gastrectomy (LSG) and multi-port LSG in terms of short-term postoperative weight loss, psychological status improvement, and patient satisfaction with incisions. It further explored the clinical advantages and potential mechanisms of single-port LSG to provide a scientific basis for individualized surgical options for obese patients.

This retrospective analysis included 341 female patients who underwent sleeve gastrectomy at Shanghai Sixth People's Hospital from September 2023 to December 2024 (100 in the single-port group and 241 in the multi-port group). Inclusion criteria were age≥18 years, meeting IFSO surgical indications, and completion of baseline data collection. Exclusion criteria included severe mental illness, history of abdominal surgery, or severe postoperative complications. Surgical procedures followed guidelines, with the single-port group using a single-port access platform and the multi-port group following standard laparoscopic procedures. Observation indicators included preoperative and 3-month postoperative weight, BMI, BAI, BDI, PSQI, and SCAR scores, with calculations of ΔBMI, %TWL, %EWL, and changes in psychological scores. Statistical analysis was performed using R 4.4.3 software. Continuous data were expressed as mean ± standard deviation, and intergroup comparisons were conducted using independent samples t-tests. Categorical data were analyzed using Fisher's exact test, and propensity score matching was performed using a 1:1 nearest-neighbor matching method. P<0.05 was considered statistically significant.

Baseline data comparison showed that the single-port group had significantly lower age, weight, BMI, BAI score, BDI score, and PSQI score than the multi-port group (P<0.05), while waist circumference, hip circumference, and waist-to-hip ratio showed no significant difference (P>0.05). Three-month postoperative follow-up results revealed that the single-port group performed significantly better in weight, BMI, BAI score, ΔBAI, BDI score, PSQI score, ΔPSQI, and SCAR score (P<0.05), but no significant differences were observed between the two groups in ΔBMI, %TWL, %EWL, or ΔBDI (P>0.05). After propensity score matching, baseline characteristics showed no significant differences (P>0.05). At three months postoperatively, the single-port group still demonstrated superior BAI score, BDI score, PSQI score, SCAR score, and changes in psychological scores (ΔBAI, ΔBDI, ΔPSQI) compared to the multi-port group (P<0.05). Mediation analysis indicated that the surgical approach had significant direct and total effects on postoperative psychological changes, but the indirect effect through SCAR score was not significant. No significant difference was observed in postoperative complication rates (P>0.05), which mainly included incision fat liquefaction, incision hematoma, pulmonary infection, and postoperative bleeding, all of which resolved after treatment.

Single-port LSG outperforms multi-port LSG in postoperative psychological improvement and incision aesthetics, but weight loss efficacy and safety are comparable. Further validation of its long-term advantages and mechanisms is warranted.