Laparoscopic port closure techniques and incidence of port-site hernias: A review and recommendations

Abstract

Minimally invasive surgeries have dawned a new era in surgical practice, cosmesis and safety. These have been heralded as one of the best surgical methods to treat a multitude of surgical disorders. Though the term minimally invasive seems attractive, in the real sense of the word, these surgeries are minimal access surgeries and do require incisions for trocars. The wounds must be closed appropriately to prevent the incidence of port-site hernia. Though rare, port-site hernias can cause considerable morbidity. Most of these are seen in the midline, particularly around the umbilicus, but there are reports of herniation at laterally placed ports. The accepted surgical practice is to close the fascial layers at all midline laparoscopic ports. There is a multitude of ways in which the ports can be closed. This article aims to review the various port closure techniques practiced by different surgeons and institutions to and reflect upon the pathophysiology of port-site hernia and recommendations to minimize them. Systematic research of the literature was performed using PubMed, Cochrane database, Google scholar and ClinicalKey. Different port-site closure techniques are described and analyzed. Though not one technique has been found to be superior to the other, all of them have their pros and cons. All of them produce similar results, and it is upon the discretion of the surgeon to accept any one of these methods. The authors have also tried to provide recommendations to minimize the incidence of port-site hernias.