Single‐incision laparoscopic hernioplasty versus multi‐incision laparoscopic hernioplasty: a meta‐analysis

Abstract

Background: Laparoscopic hernioplasty is the gold standard treatment for inguinal hernias. Recently, single-incision laparoscopic hernioplasty (SILH) has been suggested as an alternative technique. It is not evident whether the benefits of this procedure overcome the potential increased risk. Objective: The aim of this study was to compare the outcomes of SILH with conventional multi-incision laparoscopic hernioplasty (MILH) using a meta-analysis of available controlled clinical trials. Methods: Eligible articles were identified by searching several databases including Embase, Cochrane, PubMed and Google Scholar databases, up until May 2013. Evaluated outcomes were operative time, post-operative hospital stay, complications, conversion and recurrence. Results: Eight controlled clinical trials on 926 patients were randomized to either SILH (495 patients) or MILH (431 patients) for meta-analysis. Overall, there was no significant difference between SILH and MILH in complications, operative time for bilateral inguinal hernia repair, hospital stay, short-term recurrence or conversions. However, the operative time for unilateral inguinal hernia repair was significantly longer for SILH than for MILH (standardized mean difference 0.23 (95% confidence interval: 0.09-0.38); P = 0.00, I 2 = 73.6%). Conclusions: Our meta-analysis showed that SILH is feasible and safe in certain patients when compared to MILH, and carries a similar outcome, with the exception of longer operative times for unilateral inguinal hernia repair. Additional high-powered randomized trials are needed to determine whether SILH truly offers any advantages; these future studies should focus particularly on failure of technique, pain score, analgesia requirements, cosmesis and quality of life.

Laparoendoscopic single‐site surgery in inguinal hernia repair

“…According to Lai et al , the operative time for unilateral repair took significantly longer with LESS TEP than with conventional TEP ( P = 0.01), but bilateral TEP repairs took similar amounts of time. The Luo et al review reported that both unilateral and bilateral LESS TEP repairs required a longer operative time than their conventional counterparts ( P = 0.001 and P = 0.016, respectively), but were associated significantly less postoperative pain with LESS TEP technique (POD) 7 ( P = 0.021) .…”

“…Five meta‐analyses and reviews were found (Table ). Three studies compared the outcomes of various LESS and conventional LIHR , and the other two studies compared LESS and conventional TEP .…”

“…The 2014 study by Lai et al incorporated eight clinical trials—two on percutaneous extraperitoneal closure (PEC) , one on TAPP , and five on TEP —in its quantitative analysis; the eight trials had a total of 926 patients . A study by Luo et al published in 2017 included 17 clinical trials—2 on PEC , 2 on TAPP , and 13 on TEP —in its quantitative analysis; the 17 trials had a total of 1737 patients .…”

“…The studies by Lai et al and Luo et al included subgroup analysis for each IHR technique (PEC, TAPP, and TEP) and overall analysis comparing LESS and the conventional technique . Compared to the Lai et al study, the Luo et al study had more data for its TEP analysis (from three additional studies) and its TAPP analysis (from one additional study) .…”

Single-Incision Laparoscopic Inguinal Hernioplasty Versus Conventional Laparoscopic Inguinal Hernioplasty

“…13 Two previous meta-analyses that were conducted to assess SILH concluded that the procedure is feasible and safe in certain patients when compared to CLH. 7,14 However, in these meta-analyses, the number of included studies was rather small (only 3 and 8 publications, respectively). Additionally, these 2 studies included nonrandomized trials and therefore may exaggerate the inherent bias and confounding in design.…”