Three-Port Bikini Line vs. Conventional Sleeve Gastrectomy: A Prospective Cohort Study on Safety, Efficacy, and Aesthetic Outcomes.

Background: Sleeve gastrectomy becomes increasingly popular worldwide, with ongoing efforts to minimize abdominal trauma and postoperative pain and enhance aesthetic outcomes. Bikini line sleeve gastrectomy (BLSG) is a novel technique that achieves improved cosmetic results while maintaining the fundamental goal of effective weight loss. We aim to evaluate the feasibility and safety of three-port bikini sleeve gastrectomy in achieving both aesthetic satisfaction and weight reduction.

Methods: A prospective cohort study included 85 patients who underwent laparoscopic sleeve gastrectomy between October 2018 and October 2019 at Ain Shams University Hospitals, with 24-month follow-up. Based on BMI and defined anthropometric criteria, patients were allocated to Group I (n = 40), who underwent laparoscopic bikini line sleeve gastrectomy (BLSG), while Group II (n = 45), who underwent conventional laparoscopic sleeve gastrectomy (LSG). Outcomes assessed included patient satisfaction with scar appearance, percentage of excess weight loss, and early and late postoperative complications. Statistical analyses used chi-square and t-tests, with significance at p < 0.05.

Results: There was no statistically significant difference in weight loss outcomes between groups at any of the measured time points (6, 12, 18, and 24 months). The bikini line sleeve gastrectomy group reported significantly higher satisfaction with scar appearance. Despite the modest ergonomic challenges of the lower abdominal access in the bikini group, BLSG demonstrated low complication rates, confirming its safety.

Conclusions: In appropriately selected patients, three-port bikini line sleeve gastrectomy demonstrates a favourable safety profile and significantly enhances patient satisfaction while maintaining comparable clinical efficacy. Large multicentre randomized trials are warranted to further validate these outcomes. Key Points • In selected patients, three-port BLSG is reliable technique without compromising weight loss efficacy. • Three-port BLSG provides enhanced cosmetic satisfaction for patients prioritizing aesthetic outcomes. • With proper patient selection, the procedure can be safely integrated into routine practice • Future advancements in technique and instrumentation may broaden the application of three-port BLSG to patients with higher BMI and larger abdominal dimensions.