Laparoscopy port-site closure: a four-decade-challenge to an unsolved issue. A systematic review of techniques and devices

Background In the last 40 years, laparoscopic surgery has shown several benefits compared to traditional surgery, including reduced pain and faster recovery, and has spread worldwide. Nevertheless, the laparoscopic approach is associated with specific complications due to the ineffective closure of its incisions: trocar-site hernia (TSH) and abdominal wall bleeding. Present guidelines recommend to close ≥ 10-mm trocar sites, but this procedure results as being difficult, especially in obese patients. Various techniques and devices have been introduced to improve port-site closure so far and they are the object of this extensive review. Methods A systematic literature review of all articles reporting port-site closure techniques and devices was performed. Methods were classified according to Shaher’s classification. Articles with complete outcome data were included in the analysis, whereas those with incomplete data were excluded by the analysis but included in the descriptive review. Results A total of 1,251 articles were screened; 36 were included in the review and 31 in the analysis. Reported outcomes included patient BMI, operative time, and morbidity. Operative time varied largely (from 19 seconds to 8 minutes), TSH recurrence was rare (0.2%), follow-up ranged from one week to seven years, averaging 21.2 months. Conclusion Various devices and techniques have been introduced to address trocar-site closure. The surprising good results reported by authors are not consistent with clinical practice and port-site-associated morbidity (including TSH) reported in general population. Improving surgical techniques and devices, and standardizing surgical practice are needed to minimize complications and to enhance laparoscopy outcome.