Fascial Closure vs. Non-closure of Right Working Port Sites in Laparoscopic Bariatric Surgery: A Randomized Clinical...

Laparoscopic surgery offers benefits like reduced bleeding, pain, and shorter hospital stays but poses port-site complications, especially in patients with obesity. Postoperative pain is less severe than in open surgery. Multimodal analgesia is promising, while the impact of fascial closure on complications remains debated. This study aims to compare the incidence of port-site complications in patients undergoing laparoscopic bariatric surgery, with or without fascial closure of the right working port.

This randomized clinical trial was reported based on the CONSORT checklist. Seventy patients with severe obesity were compared in terms of fascial closure versus non-closure of the right working port during laparoscopic bariatric surgery. Thorough clinical, radiological, and nutritional assessment was done. Postoperative pain (using VAS) and port-site complications were assessed. Ethical approval was obtained, and informed consent was guaranteed.

Patients who underwent fascial closure of the right working port demonstrated significantly higher rates of moderate (85.7% vs. 5.7%) and severe pain (14.3% vs. 2.9%, p < 0.001) compared to the non-closure group. Port-site complications-bleeding (8.6% vs. 2.9%, p = 0.303), infection (11.4% vs. 14.3%, p = 0.721), and hernia (11.4% vs. 2.9%, p = 0.178)-were statistically comparable, suggesting that fascial closure may increase postoperative pain without significant impacts on other complications.

Fascial closure of the right working port after laparoscopic bariatric surgery in patients with obesity increases postoperative pain without reducing port-site complications like bleeding, infection, or herniation. Non-closure appears safer and effective in minimizing pain and adverse outcomes. Routine fascial closure may not be justified, warranting further research to optimize surgical techniques for patients with obesity.