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A prospective randomized controlled trial to compare single-port endo-laparoscopic surgery versus conventional TEP inguinal hernia repair

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Abstract

Introduction

The success of laparoscopic surgery is due to the less surgical trauma, including less operative pain, complications and better cosmetics. Objective of our study was to compare in two blind randomized groups of patients, the surgical outcome of total extra-peritoneal (TEP) inguinal hernia repair using either single-port or conventional surgical technique. We will report our interim results in the first group of 50 patients.

Materials and methods

Our study is a prospective, randomized, controlled clinical trial conducted from August 2011 to June 2013. Fifty patients aged between 21 and 80 years undergoing surgery for unilateral inguinal hernia were randomised into two groups: conventional laparoscopic TEP inguinal hernia repair versus single-port TEP repair. Clinical data on patient demographics, surgical technique and findings, postoperative complications and pain scores were collected. Primary endpoint is the postoperative pain while secondary endpoints are recurrence, chronic pain, postoperative hospital stay and complications.

Results

Out of the 50 patients, 26 underwent single-port hernia TEP repair and 24 had conventional 3-port TEP hernia repair after randomization. Mean operative time was 51.7 (±13.4) min in the multiport group and 59.3 (±14.9) min in the single-port group, respectively (P = 0.064). Mean hospital stay was 19.7 (±4.8) h in the conventional group and 22.1 (±4.5) h in the single-port group (P = 0.079). No statistically significant differences were observed between the two groups for postoperative complications, and no recurrence reported at 11 months follow-up. There was no significant difference in the pain scores (visual analog scale) between the two groups at regular intervals post surgery.

Discussion

The outcomes after laparoscopic TEP inguinal hernia repair with a single-port device are comparable to the standard three-port technique.

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References

  1. McKernan JB, Laws HL (1993) Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach. Surg Endosc 7:26–28

    Article  PubMed  CAS  Google Scholar 

  2. Cugura JF, Kirac I, Kulis T, Jankovic J, Beslin MB (2008) First case of single incision laparoscopic surgery for totally extraperitoneal inguinal hernia repair. Acta Clin Croat 47:249–252

    PubMed  Google Scholar 

  3. Cugura JF, Kirac I, Kulis T, Sremac M, Ledinsky M, Beslin MB (2012) Comparison of single incision laparoscopic totally extraperitoneal and laparoscopic totally extraperitoneal inguinal hernia repair: initial experience. J Endourol 26:63–66

    Article  PubMed  Google Scholar 

  4. Kim JH, Lee YS, Kim JJ, Park SM (2013) Single port laparoscopic totally extraperitoneal hernioplasty: a comparative study of short-term outcome with conventional laparoscopic totally extraperitoneal hernioplasty. World J Surg 37:746–751

    Article  PubMed  Google Scholar 

  5. Tai HC, Lin CD, Chung SD, Chueh SC, Tsai YC, Yang SS (2011) A comparative study of standard versus laparoendoscopic single-site surgery (LESS) totally extraperitoneal (TEP) inguinal hernia repair. Surg Endosc 25:2879–2883

    Article  PubMed  Google Scholar 

  6. Tsai YC, Ho CH, Tai HC, Chung SD, Chueh SC (2013) Laparoendoscopic single-site versus conventional laparoscopic total extraperitoneal hernia repair: a prospective randomized clinical trial. Surg Endosc 27:4684–4692

    Article  PubMed  Google Scholar 

  7. Miserez M, Alexandre JH, Campanelli G, Corcione F, Cuccurullo D, Pascual MH, Hoeferlin A, Kingsnorth AN, Mandala V, Palot JP, Schumpelick V, Simmermacher RK, Stoppa R, Flament JB (2007) The European hernia society groin hernia classification: simple and easy to remember. Hernia 11:113–116

    Article  PubMed  CAS  Google Scholar 

  8. Fitzgibbons RJ Jr, Camps J, Cornet DA, Nguyen NX, Litke BS, Annibali R, Salerno GM (1995) Laparoscopic inguinal herniorrhaphy. Results of a multicenter trial. Ann Surg 221:3–13

    Article  PubMed  PubMed Central  Google Scholar 

  9. Liem MS, van der Graaf Y, van Steensel CJ, Boelhouwer RU, Clevers GJ, Meijer WS, Stassen LP, Vente JP, Weidema WF, Schrijvers AJ, van Vroonhoven TJ (1997) Comparison of conventional anterior surgery and laparoscopic surgery for inguinal-hernia repair. N Engl J Med 336:1541–1547

    Article  PubMed  CAS  Google Scholar 

  10. McCormack K, Wake BL, Fraser C, Vale L, Perez J, Grant A (2005) Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair: a systematic review. Hernia 9:109–114

    Article  PubMed  CAS  Google Scholar 

  11. Krishna A, Misra MC, Bansal VK, Kumar S, Rajeshwari S, Chabra A (2012) Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial. Surg Endosc 26:639–649

    Article  PubMed  Google Scholar 

  12. Ferzli GS, Massaad A, Dysarz FA 3rd, Kopatsis A (1993) A study of 101 patients treated with extraperitoneal endoscopic laparoscopic herniorrhaphy. Am Surg 59:707–708

    PubMed  CAS  Google Scholar 

  13. Kuhry E, van Veen RN, Langeveld HR, Steyerberg EW, Jeekel J, Bonjer HJ (2007) Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic review. Surg Endosc 21:161–166

    Article  PubMed  CAS  Google Scholar 

  14. Rehman H, Rao AM, Ahmed I (2011) Single incision versus conventional multi-incision appendicectomy for suspected appendicitis. Cochrane Database Syst Rev 7(7):CD009022

    PubMed  Google Scholar 

  15. Ding J, Xia Y, Zhang ZM, Liao GQ, Pan Y, Liu S, Zhang Y, Yan Z (2013) Single-incision versus conventional three-incision laparoscopic appendicectomy for appendicitis: a systematic review and meta-analysis. J Pediatr Surg 48:1088–1098

    Article  PubMed  Google Scholar 

  16. Markar SR, Karthikesalingam A, Thrumurthy S, Muirhead L, Kinross J, Paraskeva P (2012) Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis. Surg Endosc 26:1205–1213

    Article  PubMed  CAS  Google Scholar 

  17. Garg P, Thakur JD, Garg M, Menon GR (2012) Single-incision laparoscopic cholecystectomy vs. conventional laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials. J Gastrointest Surg 16:1618–1628

    Article  PubMed  Google Scholar 

  18. Chang SK, Wang YL, Shen L, Iyer SG, Shaik AB, Lomanto D (2013) Interim report: a randomized controlled trial comparing postoperative pain in single-incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy. Asian J Endosc Surg 6:14–20

    Article  PubMed  Google Scholar 

  19. Li P, Wang DR, Wang LH, Li YK, Chen J (2012) Single-incision laparoscopic surgery vs. multiport laparoscopic surgery for colectomy: a meta-analysis of eleven recent studies. Hepatogastroenterology 59:1345–1349

    Article  PubMed  Google Scholar 

  20. Lau H, Lee F (2002) A prospective comparative study of needlescopic and conventional endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc 16:1737–1740

    Article  PubMed  CAS  Google Scholar 

  21. Goo TT, Goel R, Lawenko M, Lomanto D (2010) Laparoscopic transabdominal preperitoneal (TAPP) hernia repair via a single port. Surg Laparosc Endosc Percutan Tech 20:389–390

    Article  PubMed  Google Scholar 

  22. Kwon KH, Son BH, Han WK (2011) Laparoscopic totally extraperitoneal repair without suprapubic port: comparison with conventional totally extraperitoneal repair. J Korean Surg Soc 80:319–326

    Article  PubMed  PubMed Central  Google Scholar 

  23. Agrawal S, Shaw A, Soon Y (2010) Single-port laparoscopic totally extraperitoneal inguinal hernia repair with the TriPort system: initial experience. Surg Endosc 24:952–956

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

Authors wished to acknowledge Drs Dino Halim Liem and Chiara Montana

Disclosure

Doctors Wijerathne Sujith, Agarwal Narendra, Ramzi Ahmad and Lomanto Davide have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Minimally Invasive Surgical Centre, Department of Surgery, National University Health System, Singapore, Singapore

    Sujith Wijerathne, Narendra Agarwal, Ahmad Ramzy & Davide Lomanto

  2. Department of Surgery, National University Health System, NUHS Tower Block, Level 08, 1E, Kent Ridge Road, Singapore, 119228, Singapore

    Sujith Wijerathne

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  1. Sujith Wijerathne
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  2. Narendra Agarwal
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  3. Ahmad Ramzy
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  4. Davide Lomanto
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Correspondence to Sujith Wijerathne.

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Wijerathne, S., Agarwal, N., Ramzy, A. et al. A prospective randomized controlled trial to compare single-port endo-laparoscopic surgery versus conventional TEP inguinal hernia repair. Surg Endosc 28, 3053–3058 (2014). https://doi.org/10.1007/s00464-014-3578-7

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  • DOI: https://doi.org/10.1007/s00464-014-3578-7

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