Single-port versus multi-port laparoscopic and robotic inguinal hernia repair: a systematic review and network meta-analysis

Theethawat Thanawiboonchai; Amanda Cyntia Lima Fonseca Rodrigues; Alba Zevallos; Fatemeh Shojaeian; Brett Colton Parker; Alisa Mae Coker; Hao Deng; Gina Lynn Adrales

doi:10.1007/s00464-024-11321-9

Single-port versus multi-port laparoscopic and robotic inguinal hernia repair: a systematic review and network meta-analysis

Surg Endosc. 2024 Oct 17. doi: 10.1007/s00464-024-11321-9. Online ahead of print.

Authors

Theethawat Thanawiboonchai¹, Amanda Cyntia Lima Fonseca Rodrigues², Alba Zevallos^{3

4}, Fatemeh Shojaeian¹, Brett Colton Parker¹, Alisa Mae Coker¹, Hao Deng⁵, Gina Lynn Adrales⁶

Affiliations

¹ Division of Minimally Invasive Surgery, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
² Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³ Department of Surgery, Northwest Hospital, Randallstown, MD, USA.
⁴ Department of Medicine, Universidad Científica del Sur, Lima, Peru.
⁵ Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and, Harvard Medical School, Boston, MA, USA.
⁶ Division of Minimally Invasive Surgery, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA. gadrale1@jhmi.edu.

PMID: 39419843
DOI: 10.1007/s00464-024-11321-9

Abstract

Background: The evolution of minimally invasive surgery has transformed inguinal hernia repair (IHR). The innovative single-port technique reduces the number of surgical incisions. However, the benefits of single-port IHR remain controversial. Our systematic review and network meta-analysis assess the efficacy and clinical outcomes of single-port laparoscopic inguinal hernia repair (SPL-IHR), multi-port laparoscopic inguinal hernia repair (MPL-IHR), single-port robotic inguinal hernia repair (SPR-IHR), and multi-port robotic inguinal hernia repair (MPR-IHR).

Methods: A comprehensive search was conducted in PubMed, EMBASE, Cochrane, and Ovid for articles published before January 2024, focusing on complication rates, recurrence, seroma, hematoma, operative time, post-operative pain, and cosmetic outcomes of laparoscopic or robotic IHR. Both extraperitoneal (TEP) and transabdominal (TAPP) approaches were analyzed using MetaInsight. MPL-TAPP was used as the standard for comparison.

Results: Thirty-seven studies, including 5,038 patients, 36.92% (1,860 patients) underwent MPL-TEP, 23.64% (1,191 patients) SPL-TEP, 22.23% (1,120 patients) MPR-TAPP, 10.08% (508 patients) MPL-TAPP, 5.40% (272 patients) SPL-TAPP, and 1.73% (87 patients) SPR-TAPP. There were no significant differences in the rates of post-operative complications, hernia recurrence, hematoma, or seroma among the techniques when compared to MPL-TAPP. For secondary outcomes, MPR-TAPP significantly increased the operative time for unilateral hernia repair by a mean difference (MD) of 10.60 min [95% CI: 2.16-19.04]. Conversely, for bilateral hernia repair, there was no significant difference. Post-operative pain was significantly higher for MPL-TEP and SPL-TEP, with MDs of 1.44 [95% CI: 0.43 to 2.44] and 1.22 [95% CI: 0.18 to 2.26], respectively. SPL-TEP was significantly favored in cosmetic outcomes over MPL-TEP, with an MD of 0.65 [95% CI: 0.07 to 1.24].

Conclusion: In our network meta-analysis, the risk of post-operative complications, including recurrence, hematoma, and seroma, does not significantly vary among single-port and multi-port laparoscopic or robotic techniques. This suggests that surgical technique selection can rely on surgeon expertise and resource availability, without compromising outcomes.

Keywords: Inguinal hernia repair; Robotic inguinal hernia repair; Single port surgery; Single incision surgery; Totally Extra Peritoneal (TEP); Trans-Abdominal PrePeritoneal (TAPP).