Abou Hussein Bassem, Al Marzouqi Omar, Hajijama Sameera, Al Ani Ali, Toba Nagham, Sandal Mariam, Khokar Mohammed Amaan, Al Qasimi Hessa, Hejazi Nour AlDeen, Khamis Amar, Khammas Ali
Rashid Hospital, Dubai, United Arab Emirates.
Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
Obes Surg. 2025 May;35(5):1925-1933. doi: 10.1007/s11695-025-07827-3. Epub 2025 Mar 31.
Trocar site hernia (TsH) is an uncommon complication of bariatric surgery but potentially serious. People with obesity are more susceptible due to the difficulty in approximating fascial tissue. This study aims to investigate whether fascial closure (FC) or non-fascial closure (NFC) of trocar sites, in patients undergoing bariatric surgery, will affect the incidence of TsH.
A systematic review was conducted from July to September of 2023 and registered on Prospero 2023 CRD42023403504. The study included articles of patients who underwent bariatric surgery describing the trocar site closure technique and incidence of TsH. The exclusion criteria involved procedures using a single port, natural orifice, open, or robotic techniques. Search engines included PubMed, Medline, Scopus, and ClinicalTrials. Data collection was conducted by authors independently and disagreements were resolved as per consensus.
Out of 1433 studies that were screened, 14 cohort studies consisting of 6143 participants met the eligibility criteria. Out of the 14 studies, three compared the development of TsH between the FC and NFC groups. Two of the three reported a significantly increased incidence of TsH in the NFC group (p = 0.02, p < 0.05), whereas the remaining article reported no significant difference in incidence between the two groups. The incidence of TsH in patients undergoing FC was found to be between 0 and 11.5% by five studies consisting of 1583 patients, whereas the incidence in patients undergoing NFC was found to be between 0 and 1.6% by another set of five studies comprising 2592 patients. The study's main limitations were data heterogeneity and lack of adequate comparative literature.
Comparative and non-comparative studies investigating the incidence of TsH between FC and NFC groups revealed contradictory results. Therefore, this systematic review showed non-conclusive results and further comparative studies must be conducted with more statistical evidence to formally declare an association.
套管针穿刺部位疝（TsH）是减重手术中一种罕见但可能严重的并发症。肥胖患者因筋膜组织难以对合而更易发生。本研究旨在调查减重手术患者中，套管针穿刺部位的筋膜闭合（FC）或非筋膜闭合（NFC）是否会影响TsH的发生率。
于2023年7月至9月进行了一项系统评价，并在国际前瞻性系统评价注册库（Prospero）上注册，注册号为2023 CRD42023403504。该研究纳入了描述套管针穿刺部位闭合技术和TsH发生率的减重手术患者的文章。排除标准包括使用单孔、自然腔道、开放或机器人技术的手术。搜索引擎包括PubMed、Medline、Scopus和临床试验数据库。数据收集由作者独立进行，分歧通过共识解决。
在筛选的1433项研究中，14项队列研究（共6143名参与者）符合纳入标准。在这14项研究中，有3项比较了FC组和NFC组TsH的发生情况。其中2项报告NFC组TsH发生率显著增加（p = 0.02，p < 0.05），而其余1篇文章报告两组发生率无显著差异。由1583名患者组成的5项研究发现，接受FC的患者中TsH发生率在0至11.5%之间，而由2592名患者组成的另一组5项研究发现，接受NFC的患者中TsH发生率在0至1.6%之间。该研究的主要局限性是数据异质性和缺乏足够的比较文献。
调查FC组和NFC组之间TsH发生率的比较性和非比较性研究结果相互矛盾。因此，本系统评价结果不明确，必须进行更多具有统计学证据的进一步比较研究，以正式确定两者之间的关联。
