Hao Lai1, Guojian Li, Jun Xiao, Yuan Lin, Bangyu Lu. 1. Department of Gastrointestinal Surgery, Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China.
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.
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.