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Published in: Surgical Endoscopy 12/2013

01-12-2013

Laparoendoscopic single-site versus conventional laparoscopic total extraperitoneal hernia repair: a prospective randomized clinical trial

Authors: Yao-Chou Tsai, Chen-Hsun Ho, Huai-Ching Tai, Shiu-Dong Chung, Shih-Chieh Chueh

Published in: Surgical Endoscopy | Issue 12/2013

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Abstract

Background

This study aimed to compare laparoendoscopic single-site (LESS) total extraperitoneal (TEP) repair with conventional laparoscopic TEP repair for the treatment of inguinal hernias. To date, no other studies have compared the LESS and conventional laparoscopic TEP approaches for the treatment of inguinal hernia in a prospective randomized study setting.

Methods

For this study, 100 patients undergoing inguinal hernia repair were prospectively randomized into either the LESS TEP group or the conventional laparoscopic TEP group. Pre-, intra-, and postoperative factors were recorded. The primary end point was postoperative pain. The patients were interviewed at outpatient clinics at 1 week, 3 months, and 6 months postoperatively.

Results

The demographic data were comparable between the two groups. The median operative time was longer in the LESS TEP group (63.5 min) than in the conventional TEP group (50.5 min) (p = 0.001). No conversion was performed in either group. The mean pain score 2 h postoperatively during rest was significantly higher in the conventional TEP group than in the LESS TEP group (3.9 vs. 2.6; p = 0.02). The postoperative results were comparable between the groups in terms of analgesic requirements, systemic stress responses, complications, and postoperative convalescence.

Conclusions

The LESS TEP technique is associated with a longer operative time but offers the minor benefit of a reduction in immediate postoperative pain.
Literature
1.
go back to reference Memon MA, Cooper NJ, Memon B et al (2003) Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 90:1479–1492PubMedCrossRef Memon MA, Cooper NJ, Memon B et al (2003) Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 90:1479–1492PubMedCrossRef
2.
go back to reference Tsai YC, Wu CC, Yang SS (2010) Open versus minilaparoscopic herniorrhaphy for children: a prospective comparative trial with midterm follow-up evaluation. Surg Endosc 24:21–24PubMedCrossRef Tsai YC, Wu CC, Yang SS (2010) Open versus minilaparoscopic herniorrhaphy for children: a prospective comparative trial with midterm follow-up evaluation. Surg Endosc 24:21–24PubMedCrossRef
3.
go back to reference Johansson B, Hallerback B, Glise H et al (1999) Laparoscopic mesh versus open preperitoneal mesh versus conventional technique for inguinal hernia repair: a randomized multicenter trial (SCUR Hernia Repair Study). Ann Surg 230:225–231PubMedCrossRef Johansson B, Hallerback B, Glise H et al (1999) Laparoscopic mesh versus open preperitoneal mesh versus conventional technique for inguinal hernia repair: a randomized multicenter trial (SCUR Hernia Repair Study). Ann Surg 230:225–231PubMedCrossRef
4.
go back to reference Kaouk JH, Autorino R, Kim FJ et al (2011) Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1,076 cases. Eur Urol 60:998–1005PubMedCrossRef Kaouk JH, Autorino R, Kim FJ et al (2011) Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1,076 cases. Eur Urol 60:998–1005PubMedCrossRef
5.
go back to reference Hernandez JM, Morton CA, Ross S et al (2009) Laparoendoscopic single-site cholecystectomy: the first 100 patients. Am Surg 75:681–685 discussion 685–686PubMed Hernandez JM, Morton CA, Ross S et al (2009) Laparoendoscopic single-site cholecystectomy: the first 100 patients. Am Surg 75:681–685 discussion 685–686PubMed
6.
go back to reference Ganpule AP, Dhawan DR, Kurien A et al (2009) Laparoendoscopic single-site donor nephrectomy: a single-center experience. Urology 74:1238–1240PubMedCrossRef Ganpule AP, Dhawan DR, Kurien A et al (2009) Laparoendoscopic single-site donor nephrectomy: a single-center experience. Urology 74:1238–1240PubMedCrossRef
7.
go back to reference Desai MM, Berger AK, Brandina R et al (2009) Laparoendoscopic single-site surgery: initial hundred patients. Urology 74:805–812PubMedCrossRef Desai MM, Berger AK, Brandina R et al (2009) Laparoendoscopic single-site surgery: initial hundred patients. Urology 74:805–812PubMedCrossRef
8.
go back to reference Aron M, Canes D, Desai MM et al (2009) Transumbilical single-port laparoscopic partial nephrectomy. BJU Int 103:516–521PubMedCrossRef Aron M, Canes D, Desai MM et al (2009) Transumbilical single-port laparoscopic partial nephrectomy. BJU Int 103:516–521PubMedCrossRef
9.
go back to reference Agrawal S, Shaw A, Soon Y (2010) Single-port laparoscopic totally extraperitoneal inguinal hernia repair with the TriPort system: initial experience. Surg Endosc 24:952–956PubMedCrossRef Agrawal S, Shaw A, Soon Y (2010) Single-port laparoscopic totally extraperitoneal inguinal hernia repair with the TriPort system: initial experience. Surg Endosc 24:952–956PubMedCrossRef
10.
go back to reference Tracy CR, Raman JD, Cadeddu JA, Rane A (2008) Laparoendoscopic single-site surgery in urology: where have we been and where are we heading? Nat Clin Pract Urol 5:561–568PubMedCrossRef Tracy CR, Raman JD, Cadeddu JA, Rane A (2008) Laparoendoscopic single-site surgery in urology: where have we been and where are we heading? Nat Clin Pract Urol 5:561–568PubMedCrossRef
11.
go back to reference Rane A, Rao P, Rao P (2008) Single-port-access nephrectomy and other laparoscopic urologic procedures using a novel laparoscopic port (R-port). Urology 72:260–263 discussion 263–264PubMedCrossRef Rane A, Rao P, Rao P (2008) Single-port-access nephrectomy and other laparoscopic urologic procedures using a novel laparoscopic port (R-port). Urology 72:260–263 discussion 263–264PubMedCrossRef
12.
go back to reference Kaouk JH, Haber GP, Goel RK et al (2008) Single-port laparoscopic surgery in urology: initial experience. Urology 71:3–6PubMedCrossRef Kaouk JH, Haber GP, Goel RK et al (2008) Single-port laparoscopic surgery in urology: initial experience. Urology 71:3–6PubMedCrossRef
13.
go back to reference Tsai YC, Ho CH, Tai HC (2010) Laparoendoscopic single-site (LESS) retroperitoneal nephropexy with standard laparoscopic instruments. J Laparoendosc Adv Surg Tech A 20:257–260 discussion 260PubMedCrossRef Tsai YC, Ho CH, Tai HC (2010) Laparoendoscopic single-site (LESS) retroperitoneal nephropexy with standard laparoscopic instruments. J Laparoendosc Adv Surg Tech A 20:257–260 discussion 260PubMedCrossRef
14.
go back to reference Chung SD, Huang CY, Wang SM et al (2011) Laparoendoscopic single-site (LESS) retroperitoneal adrenalectomy using a homemade single-access platform and standard laparoscopic instruments. Surg Endosc 25:1251–1256PubMedCrossRef Chung SD, Huang CY, Wang SM et al (2011) Laparoendoscopic single-site (LESS) retroperitoneal adrenalectomy using a homemade single-access platform and standard laparoscopic instruments. Surg Endosc 25:1251–1256PubMedCrossRef
15.
go back to reference Chung SD, Huang CY, Wang SM et al (2010) Laparoendoscopic single-site (LESS) nephroureterectomy and en bloc resection of bladder cuff with a novel extravesical endoloop technique. Surg Innov 17:361–365PubMedCrossRef Chung SD, Huang CY, Wang SM et al (2010) Laparoendoscopic single-site (LESS) nephroureterectomy and en bloc resection of bladder cuff with a novel extravesical endoloop technique. Surg Innov 17:361–365PubMedCrossRef
16.
go back to reference Filipovic-Cugura J, Kirac I, Kulis T et al (2009) Single-incision laparoscopic surgery (SILS) for totally extraperitoneal (TEP) inguinal hernia repair: first case. Surg Endosc 23:920–921PubMedCrossRef Filipovic-Cugura J, Kirac I, Kulis T et al (2009) Single-incision laparoscopic surgery (SILS) for totally extraperitoneal (TEP) inguinal hernia repair: first case. Surg Endosc 23:920–921PubMedCrossRef
17.
go back to reference Tai HC, Lin CD, Wu CC et al (2010) Homemade transumbilical port: an alternative access for laparoendoscopic single-site surgery (LESS). Surg Endosc 24:705–708PubMedCrossRef Tai HC, Lin CD, Wu CC et al (2010) Homemade transumbilical port: an alternative access for laparoendoscopic single-site surgery (LESS). Surg Endosc 24:705–708PubMedCrossRef
18.
go back to reference Lau H (2005) Fibrin sealant versus mechanical stapling for mesh fixation during endoscopic extraperitoneal inguinal hernioplasty: a randomized prospective trial. Ann Surg 242:670–675PubMedCrossRef Lau H (2005) Fibrin sealant versus mechanical stapling for mesh fixation during endoscopic extraperitoneal inguinal hernioplasty: a randomized prospective trial. Ann Surg 242:670–675PubMedCrossRef
19.
go back to reference Tsai YC, Lin VC, Chung SD, et al (2012) Ergonomic and geometric tricks of laparoendoscopic single-site surgery (LESS) by using conventional laparoscopic instruments. Surg Endosc Epub 22 March Tsai YC, Lin VC, Chung SD, et al (2012) Ergonomic and geometric tricks of laparoendoscopic single-site surgery (LESS) by using conventional laparoscopic instruments. Surg Endosc Epub 22 March
20.
go back to reference Lin VC, Tsai YC, Chung SD et al (2012) A comparative study of multiport versus laparoendoscopic single-site adrenalectomy for benign adrenal tumors. Surg Endosc 26:1135–1139PubMedCrossRef Lin VC, Tsai YC, Chung SD et al (2012) A comparative study of multiport versus laparoendoscopic single-site adrenalectomy for benign adrenal tumors. Surg Endosc 26:1135–1139PubMedCrossRef
21.
go back to reference Best SL, Donnally C, Mir SA et al (2011) Complications during the initial experience with laparoendoscopic single-site pyeloplasty. BJU Int 108:1326–1329PubMedCrossRef Best SL, Donnally C, Mir SA et al (2011) Complications during the initial experience with laparoendoscopic single-site pyeloplasty. BJU Int 108:1326–1329PubMedCrossRef
23.
go back to reference Zheng M, Qin M, Zhao H (2012) Laparoendoscopic single-site cholecystectomy: a randomized controlled study. Minim Invasive Ther Allied Technol 21:113–117PubMedCrossRef Zheng M, Qin M, Zhao H (2012) Laparoendoscopic single-site cholecystectomy: a randomized controlled study. Minim Invasive Ther Allied Technol 21:113–117PubMedCrossRef
24.
go back to reference Tugcu V, Ilbey YO, Mutlu B, Tasci AI (2010) Laparoendoscopic single-site surgery versus standard laparoscopic simple nephrectomy: a prospective randomized study. J Endourol 24:1315–1320PubMedCrossRef Tugcu V, Ilbey YO, Mutlu B, Tasci AI (2010) Laparoendoscopic single-site surgery versus standard laparoscopic simple nephrectomy: a prospective randomized study. J Endourol 24:1315–1320PubMedCrossRef
25.
go back to reference Lirici MM, Califano AD, Angelini P, Corcione F (2011) Laparoendoscopic single-site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial. Am J Surg 202:45–52PubMedCrossRef Lirici MM, Califano AD, Angelini P, Corcione F (2011) Laparoendoscopic single-site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial. Am J Surg 202:45–52PubMedCrossRef
26.
go back to reference Lee SW, Lee JY, Kim KH, Ha US (2012) Laparoendoscopic single-site surgery versus conventional laparoscopic varicocele ligation in men with palpable varicocele: a randomized, clinical study. Surg Endosc 26:1056–1062PubMedCrossRef Lee SW, Lee JY, Kim KH, Ha US (2012) Laparoendoscopic single-site surgery versus conventional laparoscopic varicocele ligation in men with palpable varicocele: a randomized, clinical study. Surg Endosc 26:1056–1062PubMedCrossRef
27.
go back to reference Kurien A, Rajapurkar S, Sinha L et al (2011) First prize: standard laparoscopic donor nephrectomy versus laparoendoscopic single-site donor nephrectomy: a randomized comparative study. J Endourol 25:365–370PubMedCrossRef Kurien A, Rajapurkar S, Sinha L et al (2011) First prize: standard laparoscopic donor nephrectomy versus laparoendoscopic single-site donor nephrectomy: a randomized comparative study. J Endourol 25:365–370PubMedCrossRef
28.
go back to reference Fagotti A, Bottoni C, Vizzielli G et al (2011) Postoperative pain after conventional laparoscopy and laparoendoscopic single-site surgery (LESS) for benign adnexal disease: a randomized trial. Fertil Steril 96:255e2–259e2CrossRef Fagotti A, Bottoni C, Vizzielli G et al (2011) Postoperative pain after conventional laparoscopy and laparoendoscopic single-site surgery (LESS) for benign adnexal disease: a randomized trial. Fertil Steril 96:255e2–259e2CrossRef
29.
go back to reference Cho YJ, Kim ML, Lee SY et al (2012) Laparoendoscopic single-site surgery (LESS) versus conventional laparoscopic surgery for adnexal preservation: a randomized controlled study. Int J Womens Health 4:85–91PubMedCrossRef Cho YJ, Kim ML, Lee SY et al (2012) Laparoendoscopic single-site surgery (LESS) versus conventional laparoscopic surgery for adnexal preservation: a randomized controlled study. Int J Womens Health 4:85–91PubMedCrossRef
30.
go back to reference Bucher P, Pugin F, Buchs NC et al (2011) Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy. Br J Surg 98:1695–1702PubMedCrossRef Bucher P, Pugin F, Buchs NC et al (2011) Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy. Br J Surg 98:1695–1702PubMedCrossRef
31.
go back to reference Aprea G, Coppola Bottazzi E, Guida F et al (2011) Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. J Surg Res 166:e109–e112PubMedCrossRef Aprea G, Coppola Bottazzi E, Guida F et al (2011) Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. J Surg Res 166:e109–e112PubMedCrossRef
32.
go back to reference Tai HC, Lin CD, Chung SD et al (2011) A comparative study of standard versus laparoendoscopic single-site surgery (LESS) totally extraperitoneal (TEP) inguinal hernia repair. Surg Endosc 25:2879–2883PubMedCrossRef Tai HC, Lin CD, Chung SD et al (2011) A comparative study of standard versus laparoendoscopic single-site surgery (LESS) totally extraperitoneal (TEP) inguinal hernia repair. Surg Endosc 25:2879–2883PubMedCrossRef
33.
go back to reference Cugura JF, Kirac I, Kulis T et al (2012) Comparison of single-incision laparoscopic totally extraperitoneal and laparoscopic totally extraperitoneal inguinal hernia repair: initial experience. J Endourol 26:63–66PubMedCrossRef Cugura JF, Kirac I, Kulis T et al (2012) Comparison of single-incision laparoscopic totally extraperitoneal and laparoscopic totally extraperitoneal inguinal hernia repair: initial experience. J Endourol 26:63–66PubMedCrossRef
34.
go back to reference Chung SD, Huang CY, Wang SM et al (2011) Laparoendoscopic single-site totally extraperitoneal adult inguinal hernia repair: initial 100 patients. Surg Endosc 25:3579–3583PubMedCrossRef Chung SD, Huang CY, Wang SM et al (2011) Laparoendoscopic single-site totally extraperitoneal adult inguinal hernia repair: initial 100 patients. Surg Endosc 25:3579–3583PubMedCrossRef
35.
go back to reference Chung SD, Huang CY, Chueh SC et al (2011) Feasibility and safety of total extraperitoneal inguinal hernia repair after previous lower abdominal surgery: a case-control study. Surg Endosc 25:3353–3356PubMedCrossRef Chung SD, Huang CY, Chueh SC et al (2011) Feasibility and safety of total extraperitoneal inguinal hernia repair after previous lower abdominal surgery: a case-control study. Surg Endosc 25:3353–3356PubMedCrossRef
36.
go back to reference AM C, WD F, HJ B,et al (1990) Response of serum interleukin-6 in patients undergoing elective surgery of varying severity. Clin Sci 79:161–165 AM C, WD F, HJ B,et al (1990) Response of serum interleukin-6 in patients undergoing elective surgery of varying severity. Clin Sci 79:161–165
37.
go back to reference Suter M, Martinet O, Spertini F (2002) Reduced acute phase response after laparoscopic total extraperitoneal bilateral hernia repair compared to open repair with the Stoppa procedure. Surg Endosc 16:1214–1219PubMedCrossRef Suter M, Martinet O, Spertini F (2002) Reduced acute phase response after laparoscopic total extraperitoneal bilateral hernia repair compared to open repair with the Stoppa procedure. Surg Endosc 16:1214–1219PubMedCrossRef
38.
go back to reference Grande M, Tucci GF, Adorisio O et al (2002) Systemic acute-phase response after laparoscopic and open cholecystectomy. Surg Endosc 16:313–316PubMedCrossRef Grande M, Tucci GF, Adorisio O et al (2002) Systemic acute-phase response after laparoscopic and open cholecystectomy. Surg Endosc 16:313–316PubMedCrossRef
39.
go back to reference Jess P, Schultz K, Bendtzen K, Nielsen OH (2000) Systemic inflammatory responses during laparoscopic and open inguinal hernia repair: a randomised prospective study. Eur J Surg 166:540–544PubMedCrossRef Jess P, Schultz K, Bendtzen K, Nielsen OH (2000) Systemic inflammatory responses during laparoscopic and open inguinal hernia repair: a randomised prospective study. Eur J Surg 166:540–544PubMedCrossRef
40.
go back to reference Chaudhary D, Verma GR, Gupta R et al (1999) Comparative evaluation of the inflammatory mediators in patients undergoing laparoscopic versus conventional cholecystectomy. Aust N Z J Surg 69:369–372PubMedCrossRef Chaudhary D, Verma GR, Gupta R et al (1999) Comparative evaluation of the inflammatory mediators in patients undergoing laparoscopic versus conventional cholecystectomy. Aust N Z J Surg 69:369–372PubMedCrossRef
41.
go back to reference Karayiannakis AJ, Makri GG, Mantzioka A et al (1997) Systemic stress response after laparoscopic or open cholecystectomy: a randomized trial. Br J Surg 84:467–471PubMedCrossRef Karayiannakis AJ, Makri GG, Mantzioka A et al (1997) Systemic stress response after laparoscopic or open cholecystectomy: a randomized trial. Br J Surg 84:467–471PubMedCrossRef
42.
go back to reference Greco F, Hoda MR, Mohammed N et al (2012) Laparoendoscopic single-site and conventional laparoscopic radical nephrectomy result in equivalent surgical trauma: preliminary results of a single-centre retrospective controlled study. Eur Urol 61:1048–1053PubMedCrossRef Greco F, Hoda MR, Mohammed N et al (2012) Laparoendoscopic single-site and conventional laparoscopic radical nephrectomy result in equivalent surgical trauma: preliminary results of a single-centre retrospective controlled study. Eur Urol 61:1048–1053PubMedCrossRef
43.
go back to reference Park SK, Olweny EO, Best SL et al (2011) Patient-reported body image and cosmesis outcomes following kidney surgery: comparison of laparoendoscopic single-site, laparoscopic, and open surgery. Eur Urol 60:1097–1104PubMedCrossRef Park SK, Olweny EO, Best SL et al (2011) Patient-reported body image and cosmesis outcomes following kidney surgery: comparison of laparoendoscopic single-site, laparoscopic, and open surgery. Eur Urol 60:1097–1104PubMedCrossRef
Metadata
Title
Laparoendoscopic single-site versus conventional laparoscopic total extraperitoneal hernia repair: a prospective randomized clinical trial
Authors
Yao-Chou Tsai
Chen-Hsun Ho
Huai-Ching Tai
Shiu-Dong Chung
Shih-Chieh Chueh
Publication date
01-12-2013
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 12/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-013-3116-z

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