Objective To investigate the feasibility and safety of four ports laparoscopic sleeve gastrectomy (LSG) with preferential dissection of the left cardia and posterior gastric wall. Methods The clinical data of 122 patients including cases with obesity and cases with diabetes mellitus related to obesity who underwent surgery were retrospectively analyzed in our hospital from January 2017 to May 2020. LSG with four ports was performed for all patients. During operation, left cardia and posterior gastric wall were dissected preferentially to incise gastropancreatic ligament and part gastrophrenic ligament. Then short gastric vessels were dissected and cut off carefully. LSG was performed using cutting and closing instruments and the greater curvature of stomach was reinforced with absorbable sutures. Results All the patients completed the operation successfully. Median operative time was 76(62-117) min, and the intraoperative bleeding was about 20 mL. Patients were safely discharged all 4-5 days postoperative and were followed up with the period of duration 1-42 months. There was no postoperative bleeding or gastric leakage complications. Conclusions LSG with four ports in which the left cardia and posterior gastric wall are preferentially dissected and short gastric vessels are cut then have clinical value for easy to dissociate the fundus of stomach and lower technique need of assistant.