Laparoscopic incisions are closed in one or two layers depending on their size, using sutures, surgical staples, or skin glue. Small 5mm port sites typically need only skin-level closure, while ports 10mm and larger require stitching of the deeper fascial layer first to prevent hernias. The whole process takes just a few minutes per incision, but the technique matters more than you might expect for long-term healing.
Why Port Size Determines the Closure Method
During laparoscopic surgery, hollow tubes called trocars are inserted through small cuts in the abdominal wall. These ports are typically 5mm or 10-12mm in diameter. The size of each port dictates how it gets closed at the end of the procedure.
For ports 10mm and larger, surgeons close the fascia, which is the tough connective tissue layer beneath the skin and fat that holds your abdominal wall together. This deep closure is critical: in one prospective study, 94.5% of trocar-site hernias occurred at 10mm port sites, while only 5.5% occurred at 5mm sites. Most surgeons consider fascial closure mandatory at 10mm and above. Some close the fascia at anything over 10mm, while others use 12mm as their threshold. For 5mm ports, fascial closure is generally unnecessary.
Closing the Deep Layer
Fascial closure can be tricky because the surgeon is working through a very small opening. The standard approach uses absorbable sutures, typically a braided synthetic material, placed as interrupted stitches through the fascia and the thin membrane lining the abdominal cavity beneath it. The needle passes through both edges of the fascial defect, pulling them together so the tissue can heal without leaving a gap.
Because the fascia sits beneath a layer of fat, the surgeon sometimes has limited visibility. This has led to at least 29 different published techniques for fascial closure, ranging from simple hand-sutured methods to specialized instruments designed to pass a suture through the fascia under direct camera guidance. One common approach threads the needle transcutaneously, meaning through the skin surface, then catches the fascia from above rather than working blindly in the deeper tissue. The goal in every case is the same: grab a wide enough margin of fascia on both sides to create a secure repair.
Closing the Skin
Once the deeper layer is secured (or skipped, for small ports), the skin itself is closed using one of three main options.
Absorbable sutures are placed beneath the skin surface so they don’t need to be removed later. They dissolve on their own, typically 3 to 4 weeks after surgery. You may notice a small amount of drainage from the incision as the suture material breaks down, which is normal.
Non-absorbable sutures or metal staples sit on or near the skin surface and require a follow-up visit for removal, usually 7 to 10 days after surgery.
Skin glue is a medical-grade adhesive that forms a strong bond on contact with moist skin. Longer-chain formulations break down slowly and safely, avoiding tissue irritation. Glue offers several practical advantages: it’s fast to apply, seals the wound immediately, doesn’t require removal, and produces cosmetic results comparable to sutures. It’s particularly well-suited to 5mm port sites where no deep closure is needed, and its ease of use makes it popular in high-volume surgical settings.
After skin closure, many surgeons apply adhesive strips (Steri-Strips) over the incision for added support. These are left in place until they fall off on their own, usually within 10 to 14 days.
What Healing Looks Like
Laparoscopic incisions heal in predictable stages. For the first 24 hours, the cuts stay covered with a dressing. After that, you can shower and get the incisions wet, just pat them dry with a clean tissue or let them air dry. There’s no need to keep the wounds bandaged beyond 2 to 3 days, though a light dressing can make clothing more comfortable against the skin.
In the weeks that follow, you’ll likely feel a firm, swollen area around each incision site. This is called a healing ridge, and it’s a sign that tissue repair is progressing normally, not a hernia. The ridge resolves on its own over 8 to 12 weeks. One thing to keep in mind: avoid tanning the incision area for a full year after surgery, as UV exposure will permanently darken the scar.
Hernia Risk at Port Sites
The main reason fascial closure matters is hernia prevention. When the fascia isn’t repaired at a larger port site, abdominal contents can push through the gap over time. In one study that followed 76 patients and examined over 300 trocar sites with ultrasound, about 24% of patients developed a detectable hernia at a port site. That number is higher than many older estimates because ultrasound catches small hernias that aren’t obvious on physical exam alone.
Three factors consistently raise the risk: older age, higher BMI, and larger incision size. Proper fascial closure at 10mm-and-above sites is the most controllable of these variables. For 5mm ports, the fascia is small enough that it typically closes on its own during healing.
Signs of a Problem
Port site infections occur in roughly 4% of laparoscopic cases. The signs to watch for include thick, cloudy, or cream-colored discharge from the wound, redness that spreads beyond the incision edge, and skin around the site that feels warm or hot to the touch. Increasing pain when you gently press near the incision, or swelling that gets worse rather than better after the first week, also warrants a call to your surgical team. If you’re already on antibiotics and symptoms aren’t improving, that’s another reason to follow up.