A Comprehensive Review of Port-Site Closure Methods: A Four-Decade-Challenge to an Unsolved Issue

Background: In the last 40 years, laparoscopic surgery has shown several benefits, including reduced pain and faster recovery, and has spread worldwide. Although international guidelines recommend closing ≥10-mm trocar sites, specific complications due to their ineffective closure, trocar-site hernia (TSH) and abdominal wall bleeding, are becoming an issue. Since various techniques/devices have been introduced for port-site closure, this review is aimed at assessing the state of the art of port-site closure in 2026. Methods: A systematic literature review of all articles reporting port-site closure techniques and devices was performed. Methods were classified according to Shaher's classification. Due to the heterogeneity of studies and collected data, statistical analysis was not feasible. Port-site closure methods are discussed with respect to risk factors, clinical evidence of port-site morbidity, and current surgical practice. Results: A total of 1,251 articles were screened and 36 were included in the review. Reported outcomes included patient body mass index (BMI), operative time, and morbidity. Operative time varied largely (from 19 seconds to 8 minutes), TSH recurrence was rare (0.2%), follow-up ranged from one week to seven years, averaging 21.2 months. Conclusion: Various devices and techniques have been introduced to address trocar-site closure. Despite more than four decades of development, no closure method has clearly demonstrated superiority over the others. Overall, the quality of the available literature remains low, and reported outcomes are not fully consistent with clinical practice. The current state of the art is therefore characterized by the absence of a gold-standard approach. Standardized comparative studies are needed.