Comparison of therapeutic effect between single-port and conventional laparoscopic totally extraperitoneal inguinal hernia repair：a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Shiyu , YU Zhiyuan , LIU Bowen , ZHANG Xu ,  SUN Yan

Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, P. R. China;

Corresponding author：

SUN Yan, Email: sunyandoctor@163.com

Keywords：

inguinal hernia; single-port laparoscope; total extraperitoneal; operative effect; complication; meta-analysis

DOI：

10.7507/1007-9424.202107050

Video：

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Objective To systematically evaluate the effect of single-port totally extraperitoneal (SPTEP) and conventional totally extraperitoneal (CTEP) inguinal hernia repair in treatment of inguinal hernia. Methods PubMed, Cochrane Library, Embase, WanFang Data, VIP, and CNKI databases were electronically searched and the randomized controlled trial (RCT) and non-RCT studies on the efficacy and safety of SPTEP versus CTEP for patients with inguinal hernia from January 2010 to November 2019 were collected. Two reviewers independently screened literatures, extracted data, and assessed risk of bias of included studies, then the meta-analysis was performed by using RevMan5.3 software. Results A total of 17 clinical studies were included in the analysis, with 1 106 cases in the SPTEP group and 966 cases in the CTEP group. The results of meta-analysis showed that: the hospital stay [SMD=–0.12, 95%CI (–0.22, –0.02), P=0.01] and the time to resume normal activity [SMD=–1.17, 95%CI (–2.10, –0.23), P=0.01] were shorter, the satisfaction score of incision scars [SMD=0.92, 95%CI (0.31, 1.53), P<0.01] was higher in the SPTEP group as compared with the CTEP group. However, the operative time of SPTEP group was longer than that of the CTEP group both for unilateral inguinal hernia [MD=4.08, 95%CI (0.34, 7.83), P=0.03] and bilateral inguinal hernia [MD=5.53, 95%CI (0.39, 10.68), P=0.04]. There were no statistical differences in the postoperative pain score (24 h and 7 d), incidence of postoperative complications, the rate of patients satisfied with the incision, and hospitalization costs between the two groups (P>0.05). Conclusions From the results of this meta-analysis, SPTEP has some certain advantages in shortening hospital stay and returning to normal activity time, and improving incision satisfaction. However, compared with CTEP, mean operative time of SPTEP is longer. Although SPTEP has developed for several years, it is difficult to replace CTEP.

Citation： YANG Shiyu, YU Zhiyuan, LIU Bowen, ZHANG Xu, SUN Yan. Comparison of therapeutic effect between single-port and conventional laparoscopic totally extraperitoneal inguinal hernia repair：a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(5): 648-657. doi: 10.7507/1007-9424.202107050 Copy

1.	Kingsnorth AN. General introduction and history of hernia surgery//Kingsnorth AN, LeBlanc KA. Management of abdominal hernias. London: Springer, 2013: 1-22.
2.	中华医学会外科学分会腹腔镜与内镜外科学组, 中华医学会外科学分会疝与腹壁外科学组, 大中华腔镜疝外科学院. 腹股沟疝腹腔镜手术规范化操作指南. 中国实用外科杂志, 2013, 33(7): 566-570.
3.	Filipovic-Cugura J, Kirac I, Kulis T, et al. Single-incision laparoscopic surgery (SILS) for totally extraperitoneal (TEP) inguinal hernia repair: first case. Surg Endosc, 2009, 23(4): 920-921.
4.	谢智钦, 唐才喜, 胡琛. 单孔腹腔镜腹股沟疝修补术研究进展. 中国实用外科杂志, 2015, 35(11): 1251-1253.
5.	Cardinali L, Mazzetti CH, Cadenas Febres A, et al. Prospective randomized study comparing single-incision laparoscopic versus multi-trocar laparoscopic totally extraperitoneal (TEP) inguinal hernia repair at 2 years. Surg Endosc, 2018, 32(7): 3262-3272.
6.	Choi BJ, Jeong WJ, Lee IK, et al. Single-port versus conventional three-port laparoscopic totally extraperitoneal inguinal hernia repair: a randomized controlled trial. Hernia, 2016, 20(6): 789-795.
7.	Wijerathne S, Agarwal N, Ramzi A, et al. Single-port versus conventional laparoscopic total extra-peritoneal inguinal hernia repair: a prospective, randomized, controlled clinical trial. Surg Endosc, 2016, 30(4): 1356-1363.
8.	Tran H, Turingan I, Tran K, et al. Potential benefits of single-port compared to multiport laparoscopic inguinal herniorraphy: a prospective randomized controlled study. Hernia, 2014, 18(5): 731-744.
9.	Tsai YC, Ho CH, Tai HC, et al. Laparoendoscopic single-site versus conventional laparoscopic total extraperitoneal hernia repair: a prospective randomized clinical trial. Surg Endosc, 2013, 27(12): 4684-4692.
10.	Cugura JF, Kirac I, Kulis T, et al. Comparison of single incision laparoscopic totally extraperitoneal and laparoscopic totally extraperitoneal inguinal hernia repair: initial experience. J Endourol, 2012, 26(1): 63-66.
11.	Rajapandian S, Bhushan C, Sabnis SC, et al. Single incision multiport versus conventional laparoscopic inguinal hernia repair: a matched comparison. J Minim Access Surg, 2018, 14(1): 44-51.
12.	Białecki JT, Wieloch MM, Kołomecki K. Single incision approach to totally extraperitoneal inguinal hernia repair. Wideochir Inne Tech Maloinwazyjne, 2014, 9(2): 201-206.
13.	de Araújo FB, Starling ES, Maricevich M, et al. Single site and conventional totally extraperitoneal techniques for uncomplicated inguinal hernia repair: a comparative study. J Minim Access Surg, 2014, 10(4): 197-201.
14.	Han YD, Park S, Kim WR, et al. 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 A, 2017, 27(3): 253-258.
15.	Kim JH, Lee YS, Kim JJ, et al. Single port laparoscopic totally extraperitoneal hernioplasty: a comparative study of short-term outcome with conventional laparoscopic totally extraperitoneal hernioplasty. World J Surg, 2013, 37(4): 746-751.
16.	Tai HC, Lin CD, Chung SD, et al. A comparative study of standard versus laparoendoscopic single-site surgery (LESS) totally extraperitoneal (TEP) inguinal hernia repair. Surg Endosc, 2011, 25(9): 2879-2883.
17.	Sherwinter DA. Transitioning to single-incision laparoscopic inguinal herniorrhaphy. JSLS, 2010, 14(3): 353-357.
18.	Chueh KS, Lee HY, Yeh HC, et al. Comparison between single-incision and multiple-incision laparoscopic surgery for totally extraperitoneal inguinal hernia repair. Minim Invasive Ther Allied Technol, 2020, 29(5): 293-298.
19.	Zhang H, Li J, Gong M, et al. CTEP versus LESS totally extraperitoneal hernioplasty. JSLS, 2018, 22(4): e2018.00040.
20.	Wakasugi M, Masuzawa T, Tei M, et al. 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, 2015, 45(5): 606-610.
21.	Buckley FP, Vassaur H, Monsivais S, et al. Comparison of outcomes for single-incision laparoscopic inguinal herniorrhaphy and traditional three-port laparoscopic herniorrhaphy at a single institution. Surg Endosc, 2014, 28(1): 30-35.
22.	Lo CW, Yang SS, Tsai YC, et al. Comparison of laparoendoscopic single-site versus conventional multiple-port laparoscopic herniorrhaphy: a systemic review and meta-analysis. Hernia, 2016, 20(1): 21-32.
23.	狐鸣, 军良, 王婧, 等. 单孔腹腔镜技术在腹股沟疝修补术中临床应用价值的Meta分析. 中国普通外科杂志, 2016, 25(10): 1461-1469.
24.	Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa scale (NOS) for assessing the quality if nonrandomized studies in meta analyses, 2009. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
25.	Ger R, Monroe K, Duvivier R, et al. Management of indirect inguinal hernias by laparoscopic closure of the neck of the sac. Am J Surg, 1990, 159(4): 370-373.
26.	李健文. 腔镜疝修补术中应注意的问题. 中华疝和腹壁外科杂志 (电子版), 2009, 3(3): 249-253.
27.	Kim JH, An CH, Lee YS, et al. Single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP): experience of 512 procedures. Hernia, 2015, 19(3): 417-422.
28.	Kwon KH, Son BH, Han WK. Laparoscopic totally extraperitoneal repair without suprapubic port: comparison with conventional totally extraperitoneal repair. J Korean Surg Soc, 2011, 80(5): 319-326.
29.	Dapri G. 10-year experience with 1 700 single-incision laparoscopies. Surg Technol Int, 2019, 35: 71-83.
30.	金雄伟, 张浩, 张云生, 等. 比较分析行单孔腹腔镜下完全腹膜外腹股沟疝修补术与三孔TEP的临床效果. 中华疝和腹壁外科杂志 (电子版), 2016, 10(5): 343-345.
31.	Wakasugi M, Nakahara Y, Hirota M, et al. Learning curve for single-incision laparoscopic totally extraperitoneal inguinal hernia repair. Asian J Endosc Surg, 2019, 12(3): 301-305.
32.	Luo S, Wu S, Lai H, et al. Single-incision laparoscopic inguinal hernioplasty versus conventional laparoscopic inguinal hernioplasty. Surg Innov, 2017, 24(2): 171-182.
33.	Sajid MS, Khawaja AH, Sayegh M, et al. A systematic review comparing single-incision versus multi-incision laparoscopic surgery for inguinal hernia repair with mesh. Int J Surg, 2016, 29: 25-35.
34.	Shih TY, Wen KC, Lin KY, et al. Transumbilical, single-port, totally extraperitoneal, laparoscopic inguinal hernia repair using a homemade port and a conventional instrument: an initial experience. J Laparoendosc Adv Surg Tech A, 2012, 22(2): 162-164.
35.	Tran H, Tran K, Turingan I, et al. Single-incision laparoscopic inguinal herniorraphy with telescopic extraperitoneal dissection: technical aspects and potential benefits. Hernia, 2015, 19(3): 407-416.
36.	陈其龙, 严加费, 吴迪, 等. 自制简易单孔器行单孔腹腔镜全腹膜外腹股沟疝修补术. 浙江大学学报 (医学版), 2015, 44(1): 79-84.
37.	Choi BJ, Lee KJ, Lee SC. Direct application of single-port laparoscopic totally extraperitoneal (TEP) inguinal hernia repair by an experienced single-port laparoscopic surgeon who was inexperienced in conventional TEP hernia repair: initial experience with 100 cases. J Laparoendosc Adv Surg Tech A, 2014, 24(5): 333-338.
38.	Yamamoto M, Urushihara T, Itamoto T. Utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection. World J Gastrointest Surg, 2017, 9(12): 264-269.
39.	Dapri G, Gerard L, Paesmans M, et al. First 200 consecutive transumbilical single-incision laparoscopic TEPs. Hernia, 2017, 21(1): 29-35.
40.	Wakasugi M, Tei M, Akamatsu H. Single-incision totally extraperitoneal inguinal hernia repair after previous inguinal hernia repair. Surg Laparosc Endosc Percutan Tech, 2016, 26(6): e149-e152. doi: 10.1097/SLE.0000000000000346.
41.	Wakasugi M, Nakahara Y, Hirota M, et al. Efficacy of single-incision laparoscopic totally extraperitoneal repair for irreducible or incarcerated inguinal hernia. Asian J Endosc Surg, 2019, 12(1): 95-100.
42.	Tanoue K, Okino H, Kanazawa M, et al. Single-incision laparoscopic transabdominal preperitoneal mesh hernioplasty: results in 182 Japanese patients. Hernia, 2016, 20(6): 797-803.

1. Kingsnorth AN. General introduction and history of hernia surgery//Kingsnorth AN, LeBlanc KA. Management of abdominal hernias. London: Springer, 2013: 1-22.
2. 中华医学会外科学分会腹腔镜与内镜外科学组, 中华医学会外科学分会疝与腹壁外科学组, 大中华腔镜疝外科学院. 腹股沟疝腹腔镜手术规范化操作指南. 中国实用外科杂志, 2013, 33(7): 566-570.
3. Filipovic-Cugura J, Kirac I, Kulis T, et al. Single-incision laparoscopic surgery (SILS) for totally extraperitoneal (TEP) inguinal hernia repair: first case. Surg Endosc, 2009, 23(4): 920-921.
4. 谢智钦, 唐才喜, 胡琛. 单孔腹腔镜腹股沟疝修补术研究进展. 中国实用外科杂志, 2015, 35(11): 1251-1253.
5. Cardinali L, Mazzetti CH, Cadenas Febres A, et al. Prospective randomized study comparing single-incision laparoscopic versus multi-trocar laparoscopic totally extraperitoneal (TEP) inguinal hernia repair at 2 years. Surg Endosc, 2018, 32(7): 3262-3272.
6. Choi BJ, Jeong WJ, Lee IK, et al. Single-port versus conventional three-port laparoscopic totally extraperitoneal inguinal hernia repair: a randomized controlled trial. Hernia, 2016, 20(6): 789-795.
7. Wijerathne S, Agarwal N, Ramzi A, et al. Single-port versus conventional laparoscopic total extra-peritoneal inguinal hernia repair: a prospective, randomized, controlled clinical trial. Surg Endosc, 2016, 30(4): 1356-1363.
8. Tran H, Turingan I, Tran K, et al. Potential benefits of single-port compared to multiport laparoscopic inguinal herniorraphy: a prospective randomized controlled study. Hernia, 2014, 18(5): 731-744.
9. Tsai YC, Ho CH, Tai HC, et al. Laparoendoscopic single-site versus conventional laparoscopic total extraperitoneal hernia repair: a prospective randomized clinical trial. Surg Endosc, 2013, 27(12): 4684-4692.
10. Cugura JF, Kirac I, Kulis T, et al. Comparison of single incision laparoscopic totally extraperitoneal and laparoscopic totally extraperitoneal inguinal hernia repair: initial experience. J Endourol, 2012, 26(1): 63-66.
11. Rajapandian S, Bhushan C, Sabnis SC, et al. Single incision multiport versus conventional laparoscopic inguinal hernia repair: a matched comparison. J Minim Access Surg, 2018, 14(1): 44-51.
12. Białecki JT, Wieloch MM, Kołomecki K. Single incision approach to totally extraperitoneal inguinal hernia repair. Wideochir Inne Tech Maloinwazyjne, 2014, 9(2): 201-206.
13. de Araújo FB, Starling ES, Maricevich M, et al. Single site and conventional totally extraperitoneal techniques for uncomplicated inguinal hernia repair: a comparative study. J Minim Access Surg, 2014, 10(4): 197-201.
14. Han YD, Park S, Kim WR, et al. 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 A, 2017, 27(3): 253-258.
15. Kim JH, Lee YS, Kim JJ, et al. Single port laparoscopic totally extraperitoneal hernioplasty: a comparative study of short-term outcome with conventional laparoscopic totally extraperitoneal hernioplasty. World J Surg, 2013, 37(4): 746-751.
16. Tai HC, Lin CD, Chung SD, et al. A comparative study of standard versus laparoendoscopic single-site surgery (LESS) totally extraperitoneal (TEP) inguinal hernia repair. Surg Endosc, 2011, 25(9): 2879-2883.
17. Sherwinter DA. Transitioning to single-incision laparoscopic inguinal herniorrhaphy. JSLS, 2010, 14(3): 353-357.
18. Chueh KS, Lee HY, Yeh HC, et al. Comparison between single-incision and multiple-incision laparoscopic surgery for totally extraperitoneal inguinal hernia repair. Minim Invasive Ther Allied Technol, 2020, 29(5): 293-298.
19. Zhang H, Li J, Gong M, et al. CTEP versus LESS totally extraperitoneal hernioplasty. JSLS, 2018, 22(4): e2018.00040.
20. Wakasugi M, Masuzawa T, Tei M, et al. 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, 2015, 45(5): 606-610.
21. Buckley FP, Vassaur H, Monsivais S, et al. Comparison of outcomes for single-incision laparoscopic inguinal herniorrhaphy and traditional three-port laparoscopic herniorrhaphy at a single institution. Surg Endosc, 2014, 28(1): 30-35.
22. Lo CW, Yang SS, Tsai YC, et al. Comparison of laparoendoscopic single-site versus conventional multiple-port laparoscopic herniorrhaphy: a systemic review and meta-analysis. Hernia, 2016, 20(1): 21-32.
23. 狐鸣, 军良, 王婧, 等. 单孔腹腔镜技术在腹股沟疝修补术中临床应用价值的Meta分析. 中国普通外科杂志, 2016, 25(10): 1461-1469.
24. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa scale (NOS) for assessing the quality if nonrandomized studies in meta analyses, 2009. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
25. Ger R, Monroe K, Duvivier R, et al. Management of indirect inguinal hernias by laparoscopic closure of the neck of the sac. Am J Surg, 1990, 159(4): 370-373.
26. 李健文. 腔镜疝修补术中应注意的问题. 中华疝和腹壁外科杂志 (电子版), 2009, 3(3): 249-253.
27. Kim JH, An CH, Lee YS, et al. Single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP): experience of 512 procedures. Hernia, 2015, 19(3): 417-422.
28. Kwon KH, Son BH, Han WK. Laparoscopic totally extraperitoneal repair without suprapubic port: comparison with conventional totally extraperitoneal repair. J Korean Surg Soc, 2011, 80(5): 319-326.
29. Dapri G. 10-year experience with 1 700 single-incision laparoscopies. Surg Technol Int, 2019, 35: 71-83.
30. 金雄伟, 张浩, 张云生, 等. 比较分析行单孔腹腔镜下完全腹膜外腹股沟疝修补术与三孔TEP的临床效果. 中华疝和腹壁外科杂志 (电子版), 2016, 10(5): 343-345.
31. Wakasugi M, Nakahara Y, Hirota M, et al. Learning curve for single-incision laparoscopic totally extraperitoneal inguinal hernia repair. Asian J Endosc Surg, 2019, 12(3): 301-305.
32. Luo S, Wu S, Lai H, et al. Single-incision laparoscopic inguinal hernioplasty versus conventional laparoscopic inguinal hernioplasty. Surg Innov, 2017, 24(2): 171-182.
33. Sajid MS, Khawaja AH, Sayegh M, et al. A systematic review comparing single-incision versus multi-incision laparoscopic surgery for inguinal hernia repair with mesh. Int J Surg, 2016, 29: 25-35.
34. Shih TY, Wen KC, Lin KY, et al. Transumbilical, single-port, totally extraperitoneal, laparoscopic inguinal hernia repair using a homemade port and a conventional instrument: an initial experience. J Laparoendosc Adv Surg Tech A, 2012, 22(2): 162-164.
35. Tran H, Tran K, Turingan I, et al. Single-incision laparoscopic inguinal herniorraphy with telescopic extraperitoneal dissection: technical aspects and potential benefits. Hernia, 2015, 19(3): 407-416.
36. 陈其龙, 严加费, 吴迪, 等. 自制简易单孔器行单孔腹腔镜全腹膜外腹股沟疝修补术. 浙江大学学报 (医学版), 2015, 44(1): 79-84.
37. Choi BJ, Lee KJ, Lee SC. Direct application of single-port laparoscopic totally extraperitoneal (TEP) inguinal hernia repair by an experienced single-port laparoscopic surgeon who was inexperienced in conventional TEP hernia repair: initial experience with 100 cases. J Laparoendosc Adv Surg Tech A, 2014, 24(5): 333-338.
38. Yamamoto M, Urushihara T, Itamoto T. Utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection. World J Gastrointest Surg, 2017, 9(12): 264-269.
39. Dapri G, Gerard L, Paesmans M, et al. First 200 consecutive transumbilical single-incision laparoscopic TEPs. Hernia, 2017, 21(1): 29-35.
40. Wakasugi M, Tei M, Akamatsu H. Single-incision totally extraperitoneal inguinal hernia repair after previous inguinal hernia repair. Surg Laparosc Endosc Percutan Tech, 2016, 26(6): e149-e152. doi: 10.1097/SLE.0000000000000346.
41. Wakasugi M, Nakahara Y, Hirota M, et al. Efficacy of single-incision laparoscopic totally extraperitoneal repair for irreducible or incarcerated inguinal hernia. Asian J Endosc Surg, 2019, 12(1): 95-100.
42. Tanoue K, Okino H, Kanazawa M, et al. Single-incision laparoscopic transabdominal preperitoneal mesh hernioplasty: results in 182 Japanese patients. Hernia, 2016, 20(6): 797-803.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of therapeutic effect between single-port and conventional laparoscopic totally extraperitoneal inguinal hernia repair：a meta-analysis

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