Comparative Randomized Study on Outcomes of Hand Suture Technique “Flip-Flap” and Standard Suture Passer Technique in Laparoscopic Surgery

Abstract

Background: Trocar site hernia (TSH) remains a significant postoperative complication of laparoscopic surgery, and optimal port closure technique is debated, especially in resource-limited settings. Comparative evidence regarding the hand suture flip-flap and standard suture passer techniques remains insufficient, particularly in diverse populations with varied risk factors. Objective: This study aimed to evaluate and compare the effectiveness of the hand suture flip-flap technique versus the standard suture passer technique for port closure in laparoscopic surgery, focusing on the prevention of TSH and mean operative closure time. Methods: In this single-center, randomized controlled trial, 200 patients undergoing elective laparoscopic cholecystectomy or appendicectomy were randomized to either the flip-flap group or suture passer group (n = 100 each). Inclusion criteria were age 12–80 years and absence of prior hernia or midline laparotomy. Data collection included demographic characteristics, risk factors, operative details, and postoperative outcomes. The primary outcomes were TSH incidence and mean port closure time, measured at regular follow-ups. Ethical approval was obtained per the Declaration of Helsinki. Statistical analysis was performed using IBM SPSS v22.0, with chi-square and t-tests for group comparisons. Results: No TSH was observed in either group at three months. Mean port closure time was shorter in the flip-flap group (150.2 ± 30 s) versus the suture passer group (266.3 ± 35 s; p = 0.18). All postoperative complication rates were 0%. Conclusion: Both closure techniques are safe and effective in preventing trocar site hernia, with the flip-flap method offering a clinically meaningful reduction in closure time. These findings support the flexible adoption of either technique based on available resources and surgeon expertise, with broad implications for improving surgical outcomes in minimally invasive procedures.