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Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
Published on: December 23, 2022
A systematic review comparing single-incision versus multi-incision laparoscopic surgery for inguinal hernia repair
M S Sajid1, A H Khawaja1, M Sayegh2
1Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK.
Objective:
The objective of this article is to evaluate whether the surgical outcomes differ between single incision laparoscopic surgery (SILS) versus multi-incision laparoscopic surgery (MILS) for the repair of inguinal hernia.
Methods:
A systematic review of the literature on published studies reporting the surgical outcomes following SILS versus MILS for inguinal hernia repair was undertaken using the principles of meta-analysis.
Results:
Fifteen comparative studies on 1651 patients evaluating the surgical outcomes in patients undergoing SILS versus MILS for inguinal hernia repair were systematically analysed. The post-operative recovery time was significantly quicker [odds ratio, -0.35 (CI, -0.57 - 0.14), p = 0.001] following SILS compared to MILS procedure. However, the statistical equivalence was seen in outcomes of length of hospital stay, operative time both for unilateral and bilateral hernias, post-operative pain score, one-week pain score, hernia recurrence [odds ratio, 1.24 (CI, 0.47-3.23), p = 0.66], conversion [odds ratio, 1.07 (CI, 0.37-3.12), p = 0.90], and post-operative complications [odds ratio, 0.95 (CI, 0.66-1.36, p = 0.78] between two approaches. The sub-group analysis of four included randomized, controlled trials showed similarities between outcomes following SILS and MILS except slightly higher postoperative pain score in MILS group.
Conclusions:
Both SILS and MILS approaches of inguinal hernia repair are feasible, safe and can be offered to patients depending upon the availability of expertise and resources.
Insights
Single incision laparoscopic surgery (SILS) offers faster post-operative recovery compared to multi-incision laparoscopic surgery (MILS) for inguinal hernia repair. Other outcomes like hospital stay, operative time, and recurrence rates were similar between both SILS and MILS approaches.
Area of Science:
- Minimally Invasive Surgery
- Surgical Outcomes Research
- Hernia Repair Techniques
Background:
- Inguinal hernia repair is a common surgical procedure.
- Laparoscopic techniques, including single incision (SILS) and multi-incision (MILS), are utilized.
- Comparative data on surgical outcomes between SILS and MILS for inguinal hernia repair requires synthesis.
Purpose of the Study:
- To systematically review and meta-analyze published studies.
- To compare surgical outcomes between SILS and MILS for inguinal hernia repair.
- To determine if significant differences exist in key outcome metrics.
Main Methods:
- Systematic literature review and meta-analysis.
- Inclusion of fifteen comparative studies with 1651 patients.
- Analysis of outcomes including recovery time, hospital stay, operative time, pain, recurrence, conversion, and complications.
Main Results:
- Single incision laparoscopic surgery (SILS) demonstrated significantly quicker post-operative recovery (p=0.001).
- No statistical differences were observed in hospital stay, operative time, pain scores, hernia recurrence, conversion rates, or complications between SILS and MILS.
- Sub-group analysis of RCTs indicated similar outcomes, with slightly higher post-operative pain in the MILS group.
Conclusions:
- Both SILS and MILS are feasible and safe options for inguinal hernia repair.
- Patient selection can be based on surgeon expertise and available resources.
- Further research may refine the understanding of patient-specific benefits for each approach.
