Needlescopic Surgery Versus Single-port Laparoscopy for Inguinal Hernia

In recent years, 2 modifications of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair-needlescopic (nTAPP) surgery and single-port (sTAPP) surgery-have greatly improved patient outcomes over traditional approaches. For a comparison of these 2 modifications, we sought to investigate and compare the extent of surgical trauma and postoperative consequences for the abdominal wall in these two procedures.

In a retrospective study, 50 nTAPP and 35 sTAPP procedures occurring at a community hospital from November 1, 2009, through July 31, 2012 were reviewed. Intraoperative data, including length of the umbilical skin incision and operative time, were recorded. A follow-up evaluation included investigation of hernia recurrence, postoperative pain, abdominal wall mobility, cosmetic satisfaction, and period of sick leave.

The mean umbilical skin incision was 13 ± 4 mm in nTAPP vs 27 ± 3 mm in sTAPP (P < .001). The nTAPP procedure required less operating time than the sTAPP procedure (54.8 ± 16.9 minutes vs 85.9 ± 19.7 minutes; P < .001). The mean immediate postoperative pain score on the visual analog scale was 2.7 ± 2.1 in the nTAPP group and 4.4 ± 1.9 in the sTAPP group (P = .016). In addition, patients who underwent nTAPP had a shorter period of sick leave (11.2 ± 8.4 days vs 24.1 ± 20.1 days; P = .02). At the follow-up evaluation after approximately 30 months, abdominal wall mobility and cosmetic satisfaction were equally positive, with no hernia recurrence.

In patients with uncomplicated inguinal hernia, the nTAPP procedure, with less surgical trauma and operating time, has distinct advantages in reduction of immediate postoperative pain and sick leave time.