Top

Published in:

01-04-2019 | Inguinal Hernia | Review

Current status of single-port versus multi-port approach in laparoscopic inguinal hernia mesh repair: an up-to-date systematic review and meta-analysis

Authors: K. Perivoliotis, G. Tzovaras, C. Sarakatsianou, I. Baloyiannis

Published in: Hernia | Issue 2/2019

Abstract

A meta-analysis was conducted to provide an up-to-date comparison of single-port and multi-port approach, in laparoscopic inguinal hernia mesh repair. This meta-analysis was performed on the basis of the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The electronic databases (MEDLINE, Web of Science and Cochrane Central Register of Controlled Clinical Trials) were systematically screened. Fixed Effects or Random Effects model was used, according to the Cochran Q test. In total 16 eligible studies were found. There was no statistically significant difference, regarding unilateral operation duration, between the two approaches, in TEP (OR − 4.61; 95% CI − 9.70, 0.47, p = 0.08) or TAPP (OR − 1.96; 95% CI − 4.89, 0.97, p = 0.19) procedures. Similarly, in both operative modalities, no superiority of either approach was proven, in terms of conversion rate (TEP OR 0.69, p = 0.48; TAPP OR 5.46, p = 0.31), length of hospital stay (TEP WMD 0.00, p = 0.76; TAPP WMD − 0.11, p = 0.42) and overall complication rate (TEP OR 1.10, p = 0.51; TAPP OR 0.74, p = 0.43). Overall, single-port and the established multi-port approach in inguinal hernia mesh repair, are equivalent, regarding the postoperative outcomes. Given several limitations, further RCTs, of higher methodological and quality level are required.

Available only for authorised users

Jenkins JT, O’Dwyer PJ (2008) Inguinal hernias. Bmj 336:269–272. https://doi.org/10.1136/bmj.39450.428275.AD CrossRefPubMedPubMedCentral

Ruhl CE, Everhart JE (2007) Risk factors for inguinal hernia among adults in the US population. Am J Epidemiol 165:1154–1161. https://doi.org/10.1093/aje/kwm011 CrossRefPubMed

Grant A, Go P, Fingerhut A, Kingsnorth A, Merello J, O’Dwyer P, Payne J, Webb K, Scott N, Ross S, Aitola P, Anderberg B, Arvidsson D, Barkun J, Bay-Nielsen M, Beets G, Bittner R, Bringman S, Castoro C, Champault G, Dirksen C, Filipi C, Fitzgibbons R, Girao R, Hatzitheoklitos E, Hauters P, Heikkinen T, Jeekel H, Johansson B, Kald A, Kehlet H, Klingler A, Kozol R, Leibl B, McGillicuddy J, Macintyre I, Maddern G, Millat B, Nilsson E, Nordin P, Paganini A, Pappalardo G, Pedros JS, Schmitz R, Schwarz A, Shah S, Simmermacher R, Sledzinski Z, Stoker D, Tanner A, Taylor R, Treckmann J, Tschudi J, Vallribera F, van den Tol P, van Steensel C, van Vroonhoven T, Vrijland W, Wellwood J, Witkowski P, Zieren J, Collaboration EUHT (2000) Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials. Br J Surg 87:860–867. https://doi.org/10.1046/j.1365-2168.2000.01540.x CrossRef

Li J, Ji Z, Li Y (2014) Comparison of laparoscopic versus open procedure in the treatment of recurrent inguinal hernia: a meta-analysis of the results. Am J Surg 207:602–612. https://doi.org/10.1016/j.amjsurg.2013.05.008 CrossRefPubMed

Wei FX, Zhang YCL, Han W, Zhang YCL, Shao Y, Ni R (2015) Transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) for laparoscopic hernia repair: a meta-analysis. Surg Laparosc Endosc Percutan Tech 25:375–383. https://doi.org/10.1097/sle.0000000000000123 CrossRefPubMed

Filipovic-Cugura J, Kirac I, Kulis T, Jankovic J, Bekavac-Beslin M (2009) Single-incision laparoscopic surgery (SILS) for totally extraperitoneal (TEP) inguinal hernia repair: first case. Surg Endosc 23:920–921. https://doi.org/10.1007/s00464-008-0318-x CrossRefPubMed

Buenafe AAE, Lee-Ong AC (2017) Laparoendoscopic single-site surgery in inguinal hernia repair. Asian J Endosc Surg 10:244–251. https://doi.org/10.1111/ases.12401 CrossRefPubMed

Lo CW, Yang SSD, Tsai YC, Hsieh CH, Chang SJ (2016) Comparison of laparoendoscopic single-site versus conventional multiple-port laparoscopic herniorrhaphy: a systemic review and meta-analysis. Hernia 20:21–32. https://doi.org/10.1007/s10029-015-1443-9 CrossRefPubMed

Sajid MS, Khawaja AH, Sayegh M, Baig MK (2016) A systematic review comparing single-incision versus multi-incision laparoscopic surgery for inguinal hernia repair with mesh. Int J Surg 29:25–35. https://doi.org/10.1016/j.ijsu.2016.02.088 CrossRefPubMed

10.

Sajid MS, Khawaja AH, Sayegh M, Miles WF, Singh KK (2015) A systematic review comparing single port versus multiport laparoscopic inguinal hernia repair with mesh. Br J Surg 102:69

11.

Luo S, Wu S, Lai H, Mo X, Chen J (2017) Single-incision laparoscopic inguinal hernioplasty versus conventional laparoscopic inguinal hernioplasty. Surg Innov 24:171–182. https://doi.org/10.1177/1553350617690308 CrossRefPubMed

12.

Rajapandian S, Bhushan C, Sabnis SC, Jain M, Raj PP, Parathasarthi R, Senthilnathan P, Palanivelu C (2017) Single incision multiport versus conventional laparoscopic inguinal hernia repair: a matched comparison. J Minim Access Surg. https://doi.org/10.4103/jmas.JMAS_30_17 CrossRefPubMedPubMedCentral

13.

Han YD, Park S, Kim WR, Baek SJ, Hur H, Min BS, Kim NK (2017) Safety and efficacy of single-incision laparoscopic totally extraperitoneal inguinal hernia repair: comparative study with conventional laparoscopic totally extraperitoneal inguinal hernia repair. J Laparoendosc Adv Surg Tech 27:253–258. https://doi.org/10.1089/lap.2016.0336 CrossRef

14.

Ece I, Yilmaz H, Yormaz S, Sahin M (2017) Clinical outcomes of single incision laparoscopic surgery and conventional laparoscopic transabdominal preperitoneal inguinal hernia repair. J Minim Access Surg 13:37. https://doi.org/10.4103/0972-9941.181394 CrossRefPubMedPubMedCentral

15.

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. https://doi.org/10.1371/journal.pmed.1000097 CrossRefPubMedPubMedCentral

16.

Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JAC, Cochrane Bias Methods Group, Cochrane Statistical Methods Group (2011) The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928CrossRefPubMedPubMedCentral

17.

Peterson J, Welch V, Losos M, Tugwell P (2011) The Newcastle–Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses

18.

Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13. https://doi.org/10.1186/1471-2288-5-13 CrossRefPubMedPubMedCentral

19.

Sherwinter DA (2010) Transitioning to single-incision laparoscopic inguinal herniorrhaphy. Jsls 14:353–357. https://doi.org/10.4293/108680810x12924466007485 CrossRefPubMedPubMedCentral

20.

Tai HC, Lin CD, Chung SD, Chueh SCJ, Tsai YC, Yang SSD (2011) A comparative study of standard versus laparoendoscopic single-site surgery (LESS) totally extraperitoneal (TEP) inguinal hernia repair. Surg Endosc 25:2879–2883. https://doi.org/10.1007/s00464-011-1636-y CrossRefPubMed

21.

Tran H, Turingan I, Tran K, Zajkowska M, Lam V, Hawthorne W (2014) Potential benefits of single-port compared to multiport laparoscopic inguinal herniorraphy: a prospective randomized controlled study. Hernia 18:731–744. https://doi.org/10.1007/s10029-014-1261-5 CrossRefPubMed

22.

Tsai YC, Ho CH, Tai HC, Chung SD, Chueh SC (2013) Laparoendoscopic single-site versus conventional laparoscopic total extraperitoneal hernia repair: a prospective randomized clinical trial. Surg Endosc 27:4684–4692. https://doi.org/10.1007/s00464-013-3116-z CrossRefPubMed

23.

Wakasugi M, Masuzawa T, Tei M, Omori T, Ueshima S, Tori M, Akamatsu H (2015) Single-incision totally extraperitoneal inguinal hernia repair: our initial 100 cases and comparison with conventional three-port laparoscopic totally extraperitoneal inguinal hernia repair. Surg Today 45:606–610. https://doi.org/10.1007/s00595-014-0967-4 CrossRefPubMed

24.

Wijerathne S, Agarwal N, Ramzi A, Liem DH, Tan WB, Lomanto D (2016) Single-port versus conventional laparoscopic total extra-peritoneal inguinal hernia repair: a prospective, randomized, controlled clinical trial. Surg Endosc 30:1356–1363. https://doi.org/10.1007/s00464-015-4378-4 CrossRefPubMed

25.

Bialecki JT, Wieloch MM, Kolomecki K (2014) Single incision approach to totally extraperitoneal inguinal hernia repair. Wideochir Inne Tech Maloinwazyjne 9:201–206. https://doi.org/10.5114/wiitm.2014.41631 CrossRefPubMedPubMedCentral

26.

Buckley FP 3rd, Vassaur H, Monsivais S, Sharp NE, Jupiter D, Watson R, Eckford J, Buckley FP, Vassaur H, Monsivais S, Sharp NE, Jupiter D, Watson R, Eckford J (2014) Comparison of outcomes for single-incision laparoscopic inguinal herniorrhaphy and traditional three-port laparoscopic herniorrhaphy at a single institution. Surg Endosc 28:30–35. https://doi.org/10.1007/s00464-013-3145-7 CrossRefPubMed

27.

Cardinali L, Mazzetti CH, Cadenas Febres A, Repullo D, Bruyns J, Dapri G (2018) Prospective randomized study comparing single-incision laparoscopic versus multi-trocar laparoscopic totally extraperitoneal (TEP) inguinal hernia repair at 2 years. Surg Endosc 32:3262–3272. https://doi.org/10.1007/s00464-018-6045-z CrossRefPubMed

28.

Cugura JF, Kirac I, Kulis T, Sremac M, Ledinsky M, Beslin MB (2012) Comparison of single incision laparoscopic totally extraperitoneal and laparoscopic totally extraperitoneal inguinal hernia repair: initial experience. J Endourol 26:63–66. https://doi.org/10.1089/end.2011.0352 CrossRefPubMed

29.

de Araujo FBC, Starling ES, Maricevich M, Tobias-Machado M (2014) Single site and conventional totally extraperitoneal techniques for uncomplicated inguinal hernia repair: A comparative study. J Minim Access Surg 10:197–201. https://doi.org/10.4103/0972-9941.141521 CrossRefPubMedPubMedCentral

30.

Kim JHJ, Lee YS, Kim JHJ, Park SM (2013) Single port laparoscopic totally extraperitoneal hernioplasty: a comparative study of short-term outcome with conventional laparoscopic totally extraperitoneal hernioplasty. World J Surg 37:746–751. https://doi.org/10.1007/s00268-013-1925-9 CrossRefPubMed

31.

Sato H, Shimada M, Kurita N, Iwata T, Nishioka M, Morimoto S, Yoshikawa K, Miyatani T, Goto M, Kashihara H, Takasu C (2012) The safety and usefulness of the single incision, transabdominal pre-peritoneal (TAPP) laparoscopic technique for inguinal hernia. J Med Invest 59:235–240CrossRefPubMed

32.

Valentine JC, Therese D, Pigott, Rothstein HR (2010) How many studies do you need? A primer on statistical power for meta-analysis. J Educ Behav Stat 35(2):215–247CrossRef

33.

Ger R, Monroe K, Duvivier R, Mishrick A (1990) Management of indirect inguinal hernias by laparoscopic closure of the neck of the sac. Am J Surg 159:370–373CrossRefPubMed

34.

Zachariou Z (2009) Minimal invasive surgery principles. In: Pediatric surgery digest. Springer, New York, pp 117–123CrossRef

35.

Carter J, Duh Q-Y (2011) Laparoscopic repair of inguinal hernias. World J Surg 35:1519–1525. https://doi.org/10.1007/s00268-011-1030-x CrossRefPubMedPubMedCentral

36.

Wu JJ, Way JA, Eslick GD, Cox MR (2017) Transabdominal pre-peritoneal versus open repair for primary unilateral inguinal hernia: a meta-analysis. World J Surg. https://doi.org/10.1007/s00268-017-4288-9 CrossRefPubMed

37.

Scheuermann U, Niebisch S, Lyros O, Jansen-Winkeln B, Gockel I (2017) Transabdominal preperitoneal (TAPP) versus lichtenstein operation for primary inguinal hernia repair—a systematic review and meta-analysis of randomized controlled trials. BMC Surg 17:55. https://doi.org/10.1186/s12893-017-0253-7 CrossRefPubMedPubMedCentral

38.

Ciftci F, Abdulrahman I, Ibrahimoglu F, Kilic G (2015) Early-stage quantitative analysis of the effect of laparoscopic versus conventional inguinal hernia repair on physical activity. Chir 110:451–456

39.

Lauscher JC, Yafaei K, Buhr HJ, Ritz JP (2008) Laparoscopic and open inguinal hernia repair with alloplastic material: do the subjective and objective parameters differ in the long-term course? Surg Laparosc Endosc Percutan Tech 18:457–463. https://doi.org/10.1097/SLE.0b013e31817f4d70 CrossRefPubMed

40.

Sherwinter DA, Eckstein JG (2009) Feasibility study of natural orifice transluminal endoscopic surgery inguinal hernia repair. Gastrointest Endosc 70:126–130. https://doi.org/10.1016/j.gie.2008.10.019 CrossRefPubMed

41.

Charles EJ, Mehaffey JH, Tache-Leon CA, Hallowell PT, Sawyer RG, Yang Z (2017) Inguinal hernia repair: is there a benefit to using the robot? Surg Endosc. https://doi.org/10.1007/s00464-017-5911-4 CrossRefPubMedPubMedCentral

42.

Yozgatli TK, Esen E, Aytac E, Karahasanoglu T (2017) Transition from laparoscopic totally extraperitoneal inguinal hernia repair to robotic transabdominal preperitoneal inguinal hernia repair. World J Surg. https://doi.org/10.1007/s00268-017-4250-x CrossRef

43.

Kawamura H, Ishii C (2012) Mechanical analysis of the formation of forceps and scope for single-port laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 22:e168–e175. https://doi.org/10.1097/SLE.0b013e31825502a3 CrossRefPubMed

44.

He K, Chen H, Ding R, Hua R, Yao QY (2011) Single incision laparoscopic totally extraperitoneal inguinal hernia repair. Hernia 15:451–453. https://doi.org/10.1007/s10029-010-0674-z CrossRefPubMed

45.

Roy P, De A (2010) Single-incision laparoscopic TAPP mesh hernioplasty using conventional instruments: an evolving technique. Langenbecks Arch Surg 395:1157–1160. https://doi.org/10.1007/s00423-010-0656-8 CrossRefPubMed

46.

Chung SD, Huang CY, Wang SM, Hung SF, Tsai YC, Chueh SC, Yu HJ (2011) Laparoendoscopic single-site totally extraperitoneal adult inguinal hernia repair: initial 100 patients. Surg Endosc 25:3579–3583. https://doi.org/10.1007/s00464-011-1761-7 CrossRefPubMed

47.

Ishikawa N, Kawaguchi M, Shimizu S, Matsunoki A, Inaki N, Watanabe G (2010) Single-incision laparoscopic hernioplasty with the assistance of the Radius Surgical System. Surg Endosc 24:730–731. https://doi.org/10.1007/s00464-009-0633-x CrossRefPubMed

48.

MacDonald ER, Ahmed I (2010) “Scarless” laparoscopic TAPP inguinal hernia repair using a single port. Surgeon 8:179–181. https://doi.org/10.1016/j.surge.2009.11.006 CrossRefPubMed

49.

Agrawal S, Shaw A, Soon Y (2010) Single-port laparoscopic totally extraperitoneal inguinal hernia repair with the TriPort system: initial experience. Surg Endosc 24:952–956. https://doi.org/10.1007/s00464-009-0663-4 CrossRefPubMed

50.

Bansal VK, Misra MC, Babu D, Victor J, Kumar S, Sagar R, Rajeshwari S, Krishna A, Rewari V (2013) A prospective, randomized comparison of long-term outcomes: chronic groin pain and quality of life following totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair. Surg Endosc 27:2373–2382. https://doi.org/10.1007/s00464-013-2797-7 CrossRefPubMed

51.

Suguita FY, Essu FF, Oliveira LT, Iuamoto LR, Kato JM, Torsani MB, Franco AS, Meyer A, Andraus W (2017) Learning curve takes 65 repetitions of totally extraperitoneal laparoscopy on inguinal hernias for reduction of operating time and complications. Surg Endosc OTHER Interv Tech 31:3939–3945. https://doi.org/10.1007/s00464-017-5426-z CrossRef

52.

Krahenbuhl L, Schafer M, Schilling M, Kuzinkovas V, Buchler MW (1998) Simultaneous repair of bilateral groin hernias: open or laparoscopic approach? Surg Laparosc Endosc 8:313–318. https://doi.org/10.1097/00019509-199808000-00016 CrossRefPubMed

53.

Kim MJ, Hur KY (2013) Laparoscopic totally extraperitoneal inguinal hernia repair: 10-year experience of a single surgeon. Surg Laparosc Endosc Percutan Tech 23:51–54. https://doi.org/10.1097/SLE.0b013e31826e5022 CrossRefPubMed

54.

Soltes M, Pazinka P, Radonak J (2010) Laparoscopic hernioplasty TAPP in treatment of groin hernia–10 years experience. Rozhl Chir 89:384–389PubMed

55.

Li XZ, Zhang YH, Zhou MJ, Xia Q, Li W, Lu Q (2013) The effect of small dose sufentanil on emergence agitation in preschool children following sevoflurane anesthesia for elective repair of unilateral inguinal hernia. Saudi Med J 34:40–45PubMed

56.

Honigmann P, Fischer H, Kurmann A, Audige L, Schupfer G, Metzger J (2007) Investigating the effect of intra-operative infiltration with local anaesthesia on the development of chronic postoperative pain after inguinal hernia repair. A randomized placebo controlled triple blinded and group sequential study design [NCT00484731]. BMC Surg 7:22. https://doi.org/10.1186/1471-2482-7-22 CrossRefPubMedPubMedCentral

57.

Dapri G, Gerard L, Paesmans M, Cadière G-B, Saussez S (2017) First 200 consecutive transumbilical single-incision laparoscopic TEPs. Hernia 21:29–35. https://doi.org/10.1007/s10029-016-1564-9 CrossRefPubMed

58.

Tai HC, Ho CH, Tsai YC (2011) Laparoendoscopic single-site surgery: adult hernia mesh repair with homemade single port. Surg Laparosc Endosc Percutan Tech 21:42–45. https://doi.org/10.1097/SLE.0b013e31820ad65a CrossRefPubMed

59.

Smart P, Castles L (2012) Quantifying the cost of laparoscopic inguinal hernia repair. ANZ J Surg 82:809–812CrossRefPubMed

60.

Tran H (2011) Safety and efficacy of single incision laparoscopic surgery for total extraperitoneal inguinal hernia repair. Jsls 15:47–52. https://doi.org/10.4293/108680811x13022985131174 CrossRefPubMedPubMedCentral

61.

Lee YS, Kim JHG, Hong TH, Lee IK, Oh ST, Kim JHG, Badakhanian R (2011) Transumbilical single-port laparoscopic transabdominal preperitoneal repair of inguinal hernia: initial experience of single institute. Surg Laparosc Endosc Percutan Tech 21:199–202. https://doi.org/10.1097/SLE.0b013e31821e5fac CrossRefPubMed

Title: Current status of single-port versus multi-port approach in laparoscopic inguinal hernia mesh repair: an up-to-date systematic review and meta-analysis
Authors: K. Perivoliotis
G. Tzovaras
C. Sarakatsianou
I. Baloyiannis
Publication date: 01-04-2019
Publisher: Springer Paris
Keyword: Inguinal Hernia
Published in: Hernia / Issue 2/2019
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-018-01876-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Current status of single-port versus multi-port approach in laparoscopic inguinal hernia mesh repair: an up-to-date systematic review and meta-analysis

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2019

Short-term results after laparoscopic repair of giant hiatal hernias with pledgeted sutures: a retrospective analysis

Accreditation and certification requirements for hernia centers and surgeons: the ACCESS project

Identifying patients at risk for urinary retention following inguinal herniorrhaphy: a single institution study

Robotic retromuscular ventral hernia repair and transversus abdominis release: short-term outcomes and risk factors associated with perioperative complications

Titanium-coated mesh versus standard polypropylene mesh in laparoscopic inguinal hernia repair: a prospective, randomized, controlled clinical trial

Laparoscopic repair of type III/IV giant para-oesophageal herniae with biological prosthesis: a single centre experience