Fascial Closure and the Occurrence of Port-Site Hernia After Laparoscopic Surgery: A Systematic Review and Meta-Analysis

Background/Objectives: Port-site hernia (PSH) is a known complication of laparoscopic and robotic surgery, but whether routine fascial closure reduces this risk remains unclear. We examined the association between fascial closure and PSH compared with non-closure. Methods: This systematic review and meta-analysis followed PRISMA and was registered in PROSPERO (CRD420251274471). Embase, MEDLINE, APA PsycInfo, Global Health, and HMIC were searched for English-language studies up to 7 March 2026. Randomized trials and comparative observational studies reporting PSH after fascial closure versus non-closure were included. Non-comparative studies and studies without extractable PSH data were excluded. We used random-effects meta-analysis, RoB 2 and ROBINS-I for risk of bias, and GRADE to assess certainty of evidence. Results: Ten studies including 2183 patients (3 randomized trials and 7 observational studies) met the inclusion criteria. Overall, fascial closure was not associated with a statistically significant reduction in PSH (RR 0.51, 95% CI 0.25–1.07; I2 = 72%). The findings remained non-significant when randomized trials (RR 0.81, 95% CI 0.15–4.38) and observational studies (RR 0.45, 95% CI 0.19–1.06) were considered separately. In a post hoc analysis limited to studies with balanced follow-up, PSH was less frequent after closure (RR 0.38, 95% CI 0.20–0.73). Four observational studies were at serious risk of bias, and certainty of evidence ranged from very low to low. Conclusions: The available evidence does not provide a clear answer on whether routine fascial closure reduces PSH. No included study evaluated robotic procedures. More randomized studies with consistent closure techniques and adequate follow-up are needed.