RESUMEN
BACKGROUND: The aim of single incision laparoscopic surgery (SILS) and other types of trans-umbilical procedures (TU) has been to perform operations with minimal or no visible scars. However, in bariatric surgery, they are in particular demanding and the final esthetic advantage is in question given the long-term abdominal skin alteration, or abdominoplasty. We propose an alternative rationale and approach to achieve the minimal scarring concept in bariatric surgery. METHODS: A retrospective report of a straight forward method using four access ports, where three ports are concealed at either the lower panniculectomy region or the lateral folds of the umbilicus. The technique was performed on a pilot series of 65 female patients who underwent laparoscopic sleeve gastrectomy (LSG). RESULTS: The study sample had a mean age of 40.3 years and a mean BMI of 41.1 ± 4.2 kg/m(2). All procedures were completed laparoscopically. Field ergometry, working angles, and surgeon's convenience were not impaired. Mean operation time was 46 min and mean hospital stay was 2.3 days. Complications were minimal. Postoperative esthetic outcome and the rationale behind port placement were well appreciated by the patients. CONCLUSIONS: Performing LSG with the described approach is feasible, safe, and consistent with basic principles of ergometry including correct working triangulation. Esthetic outcome is up to the minimal scarring concept and future body contouring is not hampered.