Effect of Fascial Closure versus Non-fascial Closure on Developing Trocar Site Hernias (TsH) in the Bariatric Population: A Systematic Review.

Abstract

Background: Trocar site hernia (TsH) is an uncommon complication of bariatric surgery but potentially serious. People with obesity are more susceptible due to the difficulty in approximating fascial tissue. This study aims to investigate whether fascial closure (FC) or non-fascial closure (NFC) of trocar sites, in patients undergoing bariatric surgery, will affect the incidence of TsH.

Methods: A systematic review was conducted from July to September of 2023 and registered on Prospero 2023 CRD42023403504. The study included articles of patients who underwent bariatric surgery describing the trocar site closure technique and incidence of TsH. The exclusion criteria involved procedures using a single port, natural orifice, open, or robotic techniques. Search engines included PubMed, Medline, Scopus, and ClinicalTrials. Data collection was conducted by authors independently and disagreements were resolved as per consensus.

Results: Out of 1433 studies that were screened, 14 cohort studies consisting of 6143 participants met the eligibility criteria. Out of the 14 studies, three compared the development of TsH between the FC and NFC groups. Two of the three reported a significantly increased incidence of TsH in the NFC group (p = 0.02, p < 0.05), whereas the remaining article reported no significant difference in incidence between the two groups. The incidence of TsH in patients undergoing FC was found to be between 0 and 11.5% by five studies consisting of 1583 patients, whereas the incidence in patients undergoing NFC was found to be between 0 and 1.6% by another set of five studies comprising 2592 patients. The study's main limitations were data heterogeneity and lack of adequate comparative literature.

Conclusions: Comparative and non-comparative studies investigating the incidence of TsH between FC and NFC groups revealed contradictory results. Therefore, this systematic review showed non-conclusive results and further comparative studies must be conducted with more statistical evidence to formally declare an association.