Abstract: Single-incision bariatric surgery was developed to further reduce visible abdominal wall trauma and improve scar concealment while preserving the established metabolic and weight-loss benefits of conventional laparoscopy.This expert commentary reviews the evolution, clinical evidence, technical advances, and unresolved issues of single-incision bariatric surgery, with particular emphasis on single-incision laparoscopic sleeve gastrectomy.International and Chinese guidelines, systematic reviews, meta-analyses, comparative cohorts, large institutional series, and recent technical studies were narratively synthesized.Current evidence suggests that, in appropriately selected patients and experienced centers, single-incision sleeve gastrectomy achieves weight loss, remission of obesity-related comorbidities, and overall perioperative safety comparable to conventional multiport surgery.Its most consistent advantage is improved scar concealment and cosmetic satisfaction.By contrast, reductions in postoperative pain, length of stay, and time to functional recovery are small, heterogeneous, or clinically uncertain.The umbilical approach for incisional hernia, operational conflicts, learning curves, the cost of specialized instruments and evidence bias still restrict its promotion.Complex single-port surgical methods are still in the exploratory stage.The standardized development of single-port technology should adhere to safety priority, anatomical stratification, standardized operation, timely addition of auxiliary ports, and full-process quality assessment.Moreover, the true beneficiary population should be identified through multi-center prospective studies and long-term follow-up registration.

Key words: single-incision surgery; metabolic and bariatric surgery; sleeve gastrectomy; minimally invasive surgery; incisional hernia; patient selection