Laparoscopic Suitcase Technique for lateral incisional hernias enables fully laparoscopic fascial closure: a retrospective comparative study

Lateral incisional hernias represent a distinct subset of abdominal wall defects and pose specific challenges in minimally invasive surgery due to unfavorable force vectors and the absence of a central anchoring structure. Hybrid approaches combining laparoscopic dissection with open fascial closure can facilitate repair but partially negate the benefits of minimally invasive surgery. This study evaluated the safety and effectiveness of a fully laparoscopic method for fascial closure—the Laparoscopic Suitcase Technique (LST). While central traction techniques have been previously described, their standardized laparoscopic application in lateral incisional hernias has not been clearly defined. A retrospective comparative cohort study was conducted at a single tertiary referral center. Consecutive adult patients undergoing elective minimally invasive preperitoneal repair of lateral incisional hernias (EHS L1–L4, defect width ≥ 4 cm) were included. Patients treated with a hybrid approach between January 2019 and February 2020 were compared with patients treated exclusively using LST between July 2023 and January 2025. Surgical technique, mesh type, fixation, and overlap were standardized, with the method of fascial closure as the only procedural difference. Primary outcomes were operative time and 30-day postoperative complications. Secondary outcomes included length of hospital stay, mesh area, and hernia recurrence at 12 months. Thirty-three patients were included (hybrid n = 16; LST n = 17). Baseline demographic and hernia characteristics were comparable between groups. Median operative time was significantly shorter in the LST group (130.0 vs. 155.5 min, p = 0.02). Overall 30-day complication rates were similar and limited to Clavien–Dindo grade I–II events. Length of hospital stay was significantly reduced with LST (3.0 vs. 4.5 days, p < 0.001). No hernia recurrences were observed at 12-month follow-up in either group. The Laparoscopic Suitcase Technique is a safe and feasible approach that may facilitate fully laparoscopic fascial closure in selected patients. By enabling early central tension redistribution, LST facilitates controlled closure while avoiding hybrid access and preserving a fully laparoscopic workflow.