Single-port versus multi-port laparoscopic totally Extraperitoneal inguinal hernia repair: a systematic review and...

Single-incision laparoscopic totally extraperitoneal inguinal hernia repair (SIL-TEP) has gained attention for its potential to minimize surgical trauma and improve cosmesis. However, its comparative efficacy and safety versus conventional multi-port laparoscopic totally extraperitoneal repair (MTL-TEP) remain contentious.

This meta-analysis aimed to systematically evaluate the feasibility and safety of SIL-TEP compared to MTL-TEP.

A systematic literature search was conducted in databases including PubMed, Embase, and the Cochrane Library from January 2005 to June 2025. Data on postoperative outcomes were extracted and pooled for meta-analysis. Statistical analyses were performed using RevMan 5.4, calculating mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI).

Analysis of 23 studies (7 RCTs, 16 non-RCTs; 2894 patients) showed SIL-TEP had a longer unilateral operative time (MD = 4.39 min, 95% CI: 0.88-7.89, P = 0.01), though this was not significant in study design subgroup analysis. SIL-TEP offered superior early outcomes, including lower pain scores on postoperative day 7 (MD = -0.57, 95% CI: -1.09 to -0.05, P = 0.03) and higher cosmetic satisfaction (MD = 0.77, 95% CI: 0.27-1.28, P = 0.002). The techniques were comparable in bilateral operative time, overall complications (OR = 0.92, P = 0.48), hospital stay (MD = -0.02, P = 0.50), and recurrence rates (OR = 0.81, P = 0.65).

This meta-analysis suggests that SIL-TEP is a safe and feasible alternative to MTL-TEP. The pooled results indicate potential benefits of SIL-TEP in reducing early postoperative pain and achieving better cosmetic outcomes, although these advantages were not sustained in the RCT subgroup analysis. Critically, both techniques demonstrated comparable safety profiles, with no significant differences in complication rates, hospital stay, and short-to-midterm recurrence risk. SIL-TEP represents a viable surgical option that can be individualized for patients, particularly those who place a high value on minimal scarring.