SP 9.14 Fascial Closure in Laparoscopic Surgery: A Meta-Analysis of Its Impact on Port-Site Hernia, Bleeding, Infection, and Operative Time
Mohammed Al Subhi, Mohammed Al Yousufi, Abdulwahab Alomar, Mohammed Al Sibani, Younis Al-MufargiAbstract
Aims
To evaluate whether fascial closure reduces the incidence of port-site hernia (PSH) compared to non-closure in laparoscopic surgery. Secondary outcomes included bleeding, infection, and operative time.
Methods
A systematic literature search was conducted across six databases in accordance with PRISMA guidelines. Studies comparing closure versus non-closure after laparoscopic surgery were analysed using a Random-effect model. Subgroup analyses were conducted based on BMI, port size, trocar tip type, and study design. Risk ratios (RRs) and mean differences (MDs) were calculated, and heterogeneity was assessed using I².
Results
Six studies with 1,066 patients (463 closure, 603 non-closure) were included. Fascial closure reduced the risk of PSH (RR = 0.38; 95% CI 0.23-0.63; p < 0.01) with no heterogeneity (I² = 0%). Subgroup analyses showed consistent effects across study type, trocar tip, and BMI (all p > 0.05). The effect was more evident for ports ≥12 mm (RR = 0.33; 95% CI 0.17-0.65) than for 10 mm ports (RR = 0.60; 95% CI 0.01-29.83), but this difference was not statistically significant (p = 0.10). Fascial closure did not change the risk of bleeding (RR = 0.60; 95% CI 0.23-1.56) or infection (RR = 1.23; 95% CI 0.85-1.77). Operative time was longer in the closure group (MD = 13.65 min; 95% CI -5.76 to 33.05), though not significant.
Conclusion
Fascial closure of ports ≥10 mm lowers the risk of PSH without increasing bleeding or infection. Although it may add minutes to the procedure, the benefit in preventing hernia supports routine closure of larger ports.