Three vs. five trocar approach in laparoscopic sleeve gastrectomy: a comparative retrospective study of 100 patients

To compare operative outcomes, postoperative complications, and weight-loss effectiveness between three-trocar and conventional five-trocar laparoscopic sleeve gastrectomy (LSG). A retrospective cohort study of 100 patients undergoing LSG between 2022 and 2023 was conducted. Forty-eight patients underwent three-trocar LSG and 52 underwent five-trocar LSG. Demographic characteristics, operative parameters, postoperative complications, excess weight loss (%EWL), and incidence of gastroesophageal reflux disease (GERD) at 12 months were analyzed. The groups were comparable in age, sex distribution, and BMI. Operative time was significantly shorter in the three-trocar group. Length of hospital stay and rates of early and late postoperative complications did not differ significantly. Mean %EWL at 6 and 12 months was similar between groups. Three-trocar LSG was associated with shorter operative time while maintaining comparable weight-loss outcomes and overall complication rates. However, postoperative GERD occurred more frequently and remained independently associated with the three-trocar approach after multivariable adjustment. Further studies are required to clarify the clinical significance of this finding.