Fascial Closure and the Occurrence of Port-Site Hernia After Laparoscopic Surgery: A Systematic Review and Meta-Analysis
- 12nd Department of Obstetrics and Gynecology, “Aretaieion” University Hospital, 115 28 Athens, Greece
- 2Department of Obstetrics and Gynecology, Spital Männedorf, 8708 Männedorf, Switzerland
Abstract
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.
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BibTeX
@article{balafoutas2026fascial,
title = {{Fascial Closure and the Occurrence of Port-Site Hernia After Laparoscopic Surgery: A Systematic Review and Meta-Analysis}},
author = {Dimitrios Balafoutas and Konstantinos Stavridis and Panagiotis Christopoulos and Panagiotis Vakas and Nikos Vlahos},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218280},
url = {https://www.mdpi.com/2077-0383/15/21/8280},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Fascial Closure and the Occurrence of Port-Site Hernia After Laparoscopic Surgery: A Systematic Review and Meta-Analysis
AU - Dimitrios Balafoutas
AU - Konstantinos Stavridis
AU - Panagiotis Christopoulos
AU - Panagiotis Vakas
AU - Nikos Vlahos
PY - 2026
DA - 2026/10/24
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218280
UR - https://www.mdpi.com/2077-0383/15/21/8280
AB - 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.
SN - 2077-0383
ER -