Modified Bikini Line Sleeve Gastrectomy (MBLSG): Defining Surgical Landmarks and Clinical Outcomes in a Large-Scale...

Background and Objectives: Laparoscopic sleeve gastrectomy has emerged as the most widely adopted bariatric procedure in the management of morbid obesity. Despite its efficacy, postoperative scarring at port sites remains a significant aesthetic concern for patients. To mitigate this issue, we developed the Modified Bikini Line Sleeve Gastrectomy technique. This study aims to delineate the surgical steps of the Modified Bikini Line Sleeve Gastrectomy procedure, define the requisite anatomical landmarks, and contribute to the literature by retrospectively evaluating a patient cohort to determine the clinical applicability of this modified approach. Materials and Methods: The Modified Bikini Line Sleeve Gastrectomy procedure has been performed at our center since 2020. Stringent patient selection is paramount to the clinical success of this technique. Consequently, specific inclusion criteria necessitate meticulous evaluation during both the preoperative and intraoperative phases. This study delineates the critical aspects of patient selection, provides a comprehensive description of the Modified Bikini Line Sleeve Gastrectomy surgical technique, and analyzes the fundamental intraoperative considerations essential for its successful implementation. Results: A total of 906 patients (844 females, 62 males) with a mean Body Mass Index of 40.7 ± 6.6 kg/m² were included. Postoperative surgical site infection occurred in 6.2% of cases, and 0.8% required blood transfusion. At 12 months, the mean total body weight loss and excess weight loss were 35% ± 3% and 86.9% ± 31.2%, respectively. The mean postoperative cosmetic satisfaction score was 4 ± 0.8 (on a 5-point scale). Conclusions: These findings constitute the first study in the literature to demonstrate that the Modified Bikini Line Sleeve Gastrectomy technique is safe regarding complication profiles, effective in achieving weight loss goals, and yields high patient-reported cosmetic satisfaction. However, certain clinical presentations may preclude the use of this technique. Specifically, the Modified Bikini Line Sleeve Gastrectomy approach may not be suitable for patients with large hiatal hernias, a history of major upper abdominal surgery, or those with hepatomegaly (left lobe hypertrophy). Furthermore, anatomical constraints such as xiphoid-umbilical, xiphoid-pubic symphysis, and xiphoid-anterior superior iliac spine distances exceeding 25 cm, 36 cm, and 33 cm, respectively along with the presence of a redundant panniculus, represent limiting factors for this modified procedure.