To Close or Not to Close? A Meta-Analysis on Fascial Closure of Port Sites in Laparoscopic Metabolic and Bariatric Surgery.

Abstract

Objective: This study aimed to systematically evaluate the effectiveness of fascial closure (FC) compared with nonfascial closure (NFC) in reducing trocar-site hernia (TSH) and improving postoperative outcomes in laparoscopic metabolic and bariatric surgery (LMBS).

Methods: This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO. Five major databases were searched up to November 2025. Randomized controlled trials and high-quality observational studies comparing FC versus NFC in LMBS were included. Primary outcome was TSH incidence; secondary outcomes included trocar-site bleeding, wound healing, operative time, and postoperative weight loss. Effect sizes were calculated using odds ratios (OR) and mean differences (MD) with 95% CI.

Results: Four studies (1 RCT and 3 observational studies) involving 1127 patients were included. Pooled analysis showed no significant increase in TSH with NFC compared with FC (OR: 1.72, 95% CI: 0.81-3.65, P =0.16). FC did not significantly decrease trocar-site bleeding (OR: 1.67, 95% CI: 0.41-6.72, P =0.47) or improve wound healing (OR: 1.10, 95% CI: 0.53-2.28, P =0.79). No differences were observed in operative time (MD: -6.96 min, 95% CI: -35.51 to 21.59, P =0.63) or postoperative weight loss. One RCT reported substantially increased postoperative pain associated with FC.

Conclusions: Current evidence does not support a clear clinical advantage of FC in reducing TSH or improving postoperative outcomes in LMBS. Considering the potential for increased postoperative pain and substantial interstudy heterogeneity, decisions regarding FC should be individualized. Larger multicenter RCTs with standardized techniques and longer follow-up are warranted.