Yacoub Mohamed, Nashed George A, Khalifa Ahmed Y, Hassan Ahmed M
Cairo University, Giza, Egypt.
Obes Surg. 2025 May 23. doi: 10.1007/s11695-025-07917-2.
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.
腹腔镜手术具有出血少、疼痛轻、住院时间短等优点，但存在穿刺孔部位并发症，尤其是在肥胖患者中。术后疼痛比开放手术轻。多模式镇痛前景良好，而筋膜闭合对并发症的影响仍存在争议。本研究旨在比较接受腹腔镜减肥手术的患者中，右侧工作穿刺孔进行或不进行筋膜闭合时穿刺孔部位并发症的发生率。
本随机临床试验按照CONSORT清单进行报告。比较了70例重度肥胖患者在腹腔镜减肥手术期间右侧工作穿刺孔进行筋膜闭合与不进行闭合的情况。进行了全面的临床、放射学和营养评估。评估了术后疼痛（使用视觉模拟评分法）和穿刺孔部位并发症。获得了伦理批准，并确保了知情同意。
与未进行筋膜闭合的组相比，右侧工作穿刺孔进行筋膜闭合的患者中度疼痛（85.7%对5.7%）和重度疼痛（14.3%对2.9%，p<0.001）的发生率显著更高。穿刺孔部位并发症——出血（8.6%对2.9%，p=0.303）、感染（11.4%对14.3%，p=0.721）和疝（11.4%对2.9%，p=0.178）——在统计学上具有可比性，这表明筋膜闭合可能会增加术后疼痛，而对其他并发症没有显著影响。
肥胖患者腹腔镜减肥手术后右侧工作穿刺孔进行筋膜闭合会增加术后疼痛，而不会减少出血、感染或疝等穿刺孔部位并发症。不进行闭合在减轻疼痛和不良后果方面似乎更安全有效。常规的筋膜闭合可能不合理，需要进一步研究以优化肥胖患者的手术技术。
