Closure Versus Non-Closure of Working Ports in Laparoscopic Sleeve Gastrectomy

Background: Laparoscopic sleeve gastrectomy is one of the most commonly performed metabolic bariatric procedures. Port-site complications remain clinically important after laparoscopic surgery, particularly port-site hernia and postoperative pain. Fascial closure of trocar sites measuring 10 mm or larger is traditionally recommended to reduce the risk of port-site hernia; however, fascial closure may increase postoperative pain and delay functional recovery.

Aim: To compare closure versus non-closure of the working ports during laparoscopic sleeve gastrectomy with respect to port-site hernia occurrence, postoperative pain severity, and functional recovery measured by the QoR-15 score.

Design and setting: Single-centre, parallel-group randomized controlled trial conducted at Kasr Al Ainy Hospital, General Surgery Department, Faculty of Medicine, Cairo University.

Study period: Patients were enrolled from October 2024 to June 2025 and followed for one year after surgery; data collection was completed at the end of May 2026.

Randomization: An online randomization program (randomizer.org) was used to generate a random list, and each patient's allocation code was kept in an opaque sealed envelope. Patients were allocated in a 1:1 ratio to two parallel groups:

• Group A (n = 80): non-closure of the working ports (skin closure only).
• Group B (n = 80): closure of the working ports using a fascial closure device (Karl Storz SE \& Co. KG, Tuttlingen, Germany).

Preoperative assessment: Full history and clinical examination, anthropometric measurements (weight, BMI), routine laboratory investigations (complete blood count, liver and kidney function tests, coagulation profile, blood glucose, lipid profile), chest radiography, electrocardiography, anaesthetic assessment, and nutritional and psychological evaluation.

Operative technique: All operations were performed under balanced general anaesthesia with a transversus abdominis plane (TAP) block, in the supine position, with reverse Trendelenburg positioning after trocar insertion. Pneumoperitoneum was established with a Veress needle and trocars were inserted under direct vision. Dissection began approximately 4-6 cm proximal to the pylorus; the gastrocolic ligament and greater-curvature vessels were divided with an energy device and the fundus was fully mobilized up to the angle of His. A 36 Fr calibration bougie was placed along the lesser curvature and sequential stapler firings created the sleeve. Haemostasis and sleeve configuration were checked, and a methylene blue leak test was performed.

Port closure: In Group A only skin closure of the working port sites was performed. In Group B the fascial edges of the working ports were approximated under direct laparoscopic vision with the fascial closure device before skin closure.

Postoperative care: Standard care for all patients, including intravenous fluids, analgesia, early ambulation, venous thromboembolism prophylaxis and gradual oral intake according to the bariatric protocol.

Follow-up: Port-site pain at 1 week and 1 month; functional recovery (QoR-15) at 1 week; clinical examination for port-site hernia at each visit and abdominal wall ultrasound at 1 year.

Statistical analysis: Quantitative variables are expressed as mean and standard deviation and compared with Student's t-test; qualitative variables are expressed as number and percentage and compared with the chi-square or Fisher exact test. P < 0.05 is considered statistically significant.