S A Antoniou1,2,3, S Morales-Conde4, G A Antoniou5, F A Granderath6, F Berrevoet7, F E Muysoms8. 1. Center for Minimally Invasive Surgery, Neuwerk Hospital, Mönchengladbach, Germany. stavros.antoniou@hotmail.com. 2. Department of General Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece. stavros.antoniou@hotmail.com. 3. , Athinon-Souniou 11, Keratea Attikis, 19001, Athens, Greece. stavros.antoniou@hotmail.com. 4. Unidad de Gestión Clínica de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen Del Rocío, Sevilla, Spain. 5. Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK. 6. Center for Minimally Invasive Surgery, Neuwerk Hospital, Mönchengladbach, Germany. 7. Department of General and Hepatobiliary Surgery and Liver Transplantation Service, Ghent University Hospital and Medical School, Ghent, Belgium. 8. Department of Surgery, AZ Maria Middelares, Ghent, Belgium.
Abstract
BACKGROUND: Single-incision laparoscopic surgery has been developed with the objective to reduce surgical trauma, decrease associated surgical stress and to improve cosmetic outcome. However, concerns have been raised regarding the risk of trocar-site hernia following this approach. Previous meta-analyses have suggested a trend toward higher hernia rates, but have failed to demonstrate a significant difference between single-incision and conventional laparoscopic surgery. METHOD: Medline, AMED, CINAHL and CENTRAL were searched up to May 2014. Randomized controlled trials comparing single-incision and conventional laparoscopic surgery were considered for inclusion. Studies with patients aged less than 18 years and those reporting on robotic surgery were disregarded. Pooled odds ratios with 95% confidence intervals were calculated to measure the comparative risk of trocar-site hernia following single-incision and conventional laparoscopic surgery. RESULTS: Nineteen randomized trials encompassing 1705 patients were included. Trocar-site hernia occurred in 2.2% of patients in the single-incision group and in 0.7% of patients in the conventional laparoscopic surgery group (odds ratio 2.26, 95% confidence interval 1.00-5.08, p = 0.05). Sensitivity analysis of quality randomized trials validated the outcome estimates of the primary analysis. There was no heterogeneity among studies (I2 = 0%) and no evidence of publication bias. CONCLUSION: Single-incision laparoscopic surgery involving entry into the peritoneal cavity through the umbilicus is associated with a slightly higher risk of trocar-site hernia than conventional laparoscopy. Its effect on long-term morbidity and quality of life is a matter for further investigation.
BACKGROUND: Single-incision laparoscopic surgery has been developed with the objective to reduce surgical trauma, decrease associated surgical stress and to improve cosmetic outcome. However, concerns have been raised regarding the risk of trocar-site hernia following this approach. Previous meta-analyses have suggested a trend toward higher hernia rates, but have failed to demonstrate a significant difference between single-incision and conventional laparoscopic surgery. METHOD: Medline, AMED, CINAHL and CENTRAL were searched up to May 2014. Randomized controlled trials comparing single-incision and conventional laparoscopic surgery were considered for inclusion. Studies with patients aged less than 18 years and those reporting on robotic surgery were disregarded. Pooled odds ratios with 95% confidence intervals were calculated to measure the comparative risk of trocar-site hernia following single-incision and conventional laparoscopic surgery. RESULTS: Nineteen randomized trials encompassing 1705 patients were included. Trocar-site hernia occurred in 2.2% of patients in the single-incision group and in 0.7% of patients in the conventional laparoscopic surgery group (odds ratio 2.26, 95% confidence interval 1.00-5.08, p = 0.05). Sensitivity analysis of quality randomized trials validated the outcome estimates of the primary analysis. There was no heterogeneity among studies (I2 = 0%) and no evidence of publication bias. CONCLUSION: Single-incision laparoscopic surgery involving entry into the peritoneal cavity through the umbilicus is associated with a slightly higher risk of trocar-site hernia than conventional laparoscopy. Its effect on long-term morbidity and quality of life is a matter for further investigation.
Authors: Jun Ma; Maria A Cassera; Georg O Spaun; Chet W Hammill; Paul D Hansen; Shaghayegh Aliabadi-Wahle Journal: Ann Surg Date: 2011-07 Impact factor: 12.969
Authors: A Coda; M Bossotti; F Ferri; R Mattio; G Ramellini; A Poma; F Quaglino; C Filippa; A Bona Journal: Surg Laparosc Endosc Percutan Tech Date: 2000-02 Impact factor: 1.719
Authors: Stavros A Antoniou; Josep M García-Alamino; Shahab Hajibandeh; Shahin Hajibandeh; Michael Weitzendorfer; Filip E Muysoms; Frank A Granderath; George E Chalkiadakis; Klaus Emmanuel; George A Antoniou; Meropi Gioumidou; Styliani Iliopoulou-Kosmadaki; Maria Mathioudaki; Kyriakos Souliotis Journal: Surg Endosc Date: 2017-07-19 Impact factor: 4.584