Stavros A Antoniou1,2,3, Josep M García-Alamino4, Shahab Hajibandeh5, Shahin Hajibandeh5, Michael Weitzendorfer6, Filip E Muysoms7, Frank A Granderath8, George E Chalkiadakis9, Klaus Emmanuel6, George A Antoniou10, Meropi Gioumidou11, Styliani Iliopoulou-Kosmadaki11, Maria Mathioudaki11, Kyriakos Souliotis11. 1. Department of General Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece. stavros.antoniou@hotmail.com. 2. Center for Minimally Invasive Surgery, Neuwerk Hospital, Mönchengladbach, Germany. stavros.antoniou@hotmail.com. 3. , Athinon-Souniou 11, Keratea Attikis, 19001, Athens, Greece. stavros.antoniou@hotmail.com. 4. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK. 5. Department of General Surgery, Royal Blackburn Hospital, Blackburn, UK. 6. Department of Surgery, Paracelsus Medical University, Salzburg, Austria. 7. Department of Surgery, AZ Maria Middelares, Ghent, Belgium. 8. Center for Minimally Invasive Surgery, Neuwerk Hospital, Mönchengladbach, Germany. 9. Department of General Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece. 10. Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK. 11. School of Medicine, University of Crete, Heraklion, Crete, Greece.
Abstract
BACKGROUND: Single-incision laparoscopic surgery (SILS) is a new technique that aims to minimize abdominal wall trauma and improve cosmesis. Concerns have been raised about the risk of trocar-site hernia following SILS. This study aims to assess the risk of trocar-site hernia following SILS compared to conventional laparoscopic surgery, and investigate whether current evidence is conclusive. METHODS: We performed a systematic search of MEDLINE, AMED, CINAHL, CENTRAL, and OpenGrey. We considered randomized clinical trials comparing the risk of trocar-site hernia with SILS and conventional laparoscopic surgery. Pooled odds ratios with 95% confidence intervals (CI) were calculated using the Mantel-Haenszel method. Trial sequential analysis using the Land and DeMets method was performed to assess the possibility of type I error and compute the information size. RESULTS: Twenty-three articles reporting a total of 2471 patients were included. SILS was associated with higher odds of trocar-site hernia compared to conventional laparoscopic surgery (odds ratio 2.37, 95% CI 1.25-4.50, p = 0.008). There was no evidence of between-study heterogeneity or small-study effects. The information size was calculated at 1687 patients and the Z-curve crossed the O'Brien-Fleming α-spending boundaries at 1137 patients, suggesting that the evidence of higher risk of trocar-site hernia with SILS compared to conventional laparoscopic surgery can be considered conclusive. CONCLUSIONS: Single-incision laparoscopic procedures through the umbilicus are associated with a higher risk of trocar-site hernia compared to conventional laparoscopic surgery.
BACKGROUND: Single-incision laparoscopic surgery (SILS) is a new technique that aims to minimize abdominal wall trauma and improve cosmesis. Concerns have been raised about the risk of trocar-site hernia following SILS. This study aims to assess the risk of trocar-site hernia following SILS compared to conventional laparoscopic surgery, and investigate whether current evidence is conclusive. METHODS: We performed a systematic search of MEDLINE, AMED, CINAHL, CENTRAL, and OpenGrey. We considered randomized clinical trials comparing the risk of trocar-site hernia with SILS and conventional laparoscopic surgery. Pooled odds ratios with 95% confidence intervals (CI) were calculated using the Mantel-Haenszel method. Trial sequential analysis using the Land and DeMets method was performed to assess the possibility of type I error and compute the information size. RESULTS: Twenty-three articles reporting a total of 2471 patients were included. SILS was associated with higher odds of trocar-site hernia compared to conventional laparoscopic surgery (odds ratio 2.37, 95% CI 1.25-4.50, p = 0.008). There was no evidence of between-study heterogeneity or small-study effects. The information size was calculated at 1687 patients and the Z-curve crossed the O'Brien-Fleming α-spending boundaries at 1137 patients, suggesting that the evidence of higher risk of trocar-site hernia with SILS compared to conventional laparoscopic surgery can be considered conclusive. CONCLUSIONS: Single-incision laparoscopic procedures through the umbilicus are associated with a higher risk of trocar-site hernia compared to conventional laparoscopic surgery.
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