Port-site hernia following laparoscopic gynecological surgery: A systematic review and meta-analysis.

Abstract

Introduction: Port-site hernia (PSH) is a rare but clinically relevant complication of laparoscopic gynecologic surgery. Despite the widespread adoption of minimally invasive techniques, no prior systematic review has comprehensively evaluated PSH incidence and risk factors in this population.

Material and methods: A systematic review and meta-analysis were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD42025649280). PubMed, Scopus, Web of Science, and Embase were searched without language or date restrictions. Eligible studies included randomized or cohort designs reporting PSH incidence after laparoscopic gynecologic procedures. Pooled incidence was calculated using a random-effects model.

Results: Twenty-two studies comprising 70 346 patients were included. The overall pooled PSH incidence was 0.29% (95% CI: 0.00 to 0.02), with significant heterogeneity (I² = 99.3%). Sensitivity analysis excluding outliers reduced heterogeneity (I² = 83.1%) without altering direction or significance. Elevated body mass index (BMI), diabetes mellitus, and advanced age were consistent patient-related risk factors, while larger trocar size (≥10 mm), single-port access, and inadequate fascial closure were major surgical contributors.

Conclusions: PSH following laparoscopic gynecologic surgery remains a rare but clinically significant occurrence. Surgical technique, particularly trocar size selection and fascial closure, plays a decisive role in risk reduction. Attention to modifiable intraoperative factors is crucial for optimizing patient safety and preventing postoperative hernia formation.