Comparison of laparoendoscopic single-site versus conventional multiple-port laparoscopic herniorrhaphy: a systemic review and meta-analysis

Purpose: We systemically reviewed published literatures and performed meta-analysis to compare the surgical outcomes between laparoendoscopic single-site over the multiple-port total extraperitoneal approach in hernia repair. Methods: We did a systemic search of PubMed^® and Cochrane review for all randomized controlled trials and comparative trials that compared the efficacy and safety between LESS-TEP and MP-TEP. The evaluated outcomes included perioperative parameters (operative time, conversion rate), hospital stay and complications (seroma, delayed return of bladder function, postoperative pain and recurrence). The Cochrane Collaboration Review Manager software (RevMan^®, version 5.2.6) was used for statistical analysis. Results: There were 10 trials met the inclusion criteria and included for meta-analysis. Totally, there were 595 and 514 patients underwent LESS-TEP and MP-TEP, respectively. The LESS-TEP took significantly longer-operative time than the MP-TEP in unilateral hernia repair (weighted mean difference (WMD) 4.11 min, 95 % CI 0.76–7.46, p = 0.02) while not in bilateral hernia repair (WMD 3.87 min, 95 % of CI −2.59–10.33, z = 1.17, p = 0.24). There were no significant differences in surgical outcomes with regard to postoperative pain scale, conversion rate, hospital stay, recurrence rate and complication rate between two groups. The length of the sub-umbilical wound was the same in both groups. The result of cosmesis was not compared because of the limited data. Conclusion: In experienced hands, LESS-TEP is a feasible alternative to MP-TEP with comparable surgical efficacy and morbidity, but with longer operation time in unilateral hernia repair. Potential advantages of LESS-TEP including better cosmesis, less postoperative pain and less trocar-associated complications were not clearly shown.