Risk of complications following laparoscopic sleeve gastrectomy for morbid obesity: a systematic review

Abstract

Laparoscopic sleeve gastrectomy (LSG) has emerged as one of the most frequently performed bariatric procedures for the management of morbid obesity. Although LSG is considered technically simpler than other bariatric operations, it is still associated with a range of postoperative complications that may influence patient outcomes. Reported complication rates vary widely across studies due to differences in patient characteristics, surgical techniques, perioperative protocols, and institutional experience. This systematic review and meta-analysis, conducted in accordance with PRISMA 2020 guidelines, evaluated studies published between January 2010 and December 2025 reporting complications following laparoscopic sleeve gastrectomy for morbid obesity. Eligible studies included adult patients undergoing primary LSG with documented perioperative outcomes. Data extraction and quality assessment were performed independently by reviewers. Random-effects meta-analysis was applied where appropriate, and heterogeneity was assessed using the I² statistic. The pooled evidence demonstrated that LSG is associated with relatively low overall complication rates; however, clinically significant complications such as staple line leak, bleeding, stenosis, and gastroesophageal reflux disease were reported. Patient-related factors including high body mass index (BMI), comorbidities, and surgeon experience influenced complication risk. Early detection and standardized perioperative management were associated with improved outcomes. Overall, laparoscopic sleeve gastrectomy remains a safe and effective bariatric procedure, though careful patient selection and optimized surgical technique are essential to minimize complications. Variability among studies highlights the need for standardized reporting and further high-quality research.