# Surgeons' Preference Regarding Port Site Closure and Incidence of Port Site Hernias in Bariatric Surgery: A Retrospective Multicentre Study Across Peshawar, Pakistan

## TL;DR

This study examines how often port site hernias occur after bariatric surgery in Pakistan and surgeon preferences for closing incisions.

## Contribution

The study provides new insights into port site hernia incidence and surgeon preferences in a specific regional context.

## Key findings

- The incidence of port site hernias was 1.5% among 650 patients.
- Hernias occurred more frequently at larger port sites and in patients with comorbidities.
- Simple skin closure was the preferred method for port site closure.

## Abstract

Introduction

Laparoscopic bariatric surgery is gaining popularity among the people of Pakistan because of increasing obesity and awareness about minimal access surgery. However, bariatric surgery is associated with certain potential complications. Port site hernias (PSHs) are one such complication and can be symptomatic or asymptomatic. The purpose of our study was to find the incidence of PSHs in our patients and the preference of operating surgeons regarding port site closure techniques.

Materials and methods

This study was conducted retrospectively by reviewing patients' records, history and examination with imaging, if necessary. Six hundred and fifty patients were included in the study who were operated between 2019 and 2024 across different centres in Peshawar. Data was collected about patients' age, gender, any comorbidities, type of surgery, surgeon preference for the closure technique and incidence of PSHs. Data was analysed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States).

Results

The incidence of PSHs in our patients was 1.5% (10 cases in 650). Three of the hernias occurred at a 10mm camera port site while others occurred at a 12mm left-side port site. Six of the patients were hypertensive and two were diabetic. Of the procedures performed, 202 were laparoscopic sleeve gastrectomy, 185 were laparoscopic roux-en-y gastric bypass and 263 were laparoscopic one anastomosis gastric bypass. All the port sites were closed using simple closure of skin incision only.

Conclusion

The incidence of symptomatic PSHs is low in our patients. The incidence of PSHs increases with the increase in the size of the port and comorbidities of patients. Simple skin closure was preferred by surgeons as it can reduce operative time, postop pain, surgical site infection and financial burden. However, further studies are needed for an ideal closing technique for port sites and to assess whether such closure decreases the incidence of PSHs.