Fascial closure versus non-closure of laparoscopic port sites: a systematic review and meta-analysis.

BACKGROUND: Fascial closure of laparoscopic port sites remains controversial, particularly regarding its role in preventing port-site hernia and other postoperative complications. This meta-analysis aimed to evaluate the effect of fascial closure on port-site hernia, surgical site infection, bleeding, and operative time. METHODS: A meta-analysis of six studies involving 1,066 patients (463 closure and 603 non-closure) was conducted. Outcomes assessed included port-site hernia, surgical site infection, bleeding, and operative time. Random-effects models were used to calculate pooled risk ratios (RRs), risk differences (RDs), and mean differences (MDs). Prespecified subgroup analyses were performed according to body mass index (BMI), port size, trocar tip type, and study design. Heterogeneity was assessed using the I² statistic. RESULTS: Six studies comprising 1,066 patients were included in the quantitative synthesis. Fascial closure was associated with a significantly lower relative risk of port-site hernia (RR 0.38, 95% CI 0.23–0.63; p < 0.01). However, the pooled absolute risk difference was small and not statistically significant (RD − 0.01, 95% CI − 0.03 to 0.00). No significant differences were observed between closure and non-closure groups for surgical site infection, bleeding, or operative time. CONCLUSION: Fascial closure was associated with a reduced relative risk of port-site hernia, although the absolute benefit was small. No significant differences were observed in infection, bleeding, or operative time. Fascial closure may be considered, particularly for larger ports and higher-risk patients.