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

Autor: Thanawiboonchai T; Division of Minimally Invasive Surgery, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA., Cyntia Lima Fonseca Rodrigues A; Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA., Zevallos A; Department of Surgery, Northwest Hospital, Randallstown, MD, USA.; Department of Medicine, Universidad Científica del Sur, Lima, Peru., Shojaeian F; Division of Minimally Invasive Surgery, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA., Parker BC; Division of Minimally Invasive Surgery, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA., Coker AM; Division of Minimally Invasive Surgery, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA., Deng H; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and, Harvard Medical School, Boston, MA, USA., Adrales GL; Division of Minimally Invasive Surgery, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA. gadrale1@jhmi.edu.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2025 Jan; Vol. 39 (1), pp. 530-544. Date of Electronic Publication: 2024 Oct 17.
DOI: 10.1007/s00464-024-11321-9
Abstrakt: 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.
Competing Interests: Declarations. Disclosures: Theethawat Thanawiboonchai, Amanda Cyntia Lima Fonseca Rodrigues, Alba Zevallos, Fatemeh Shojaeian, and Hao Deng have no conflicts of interest. Brett Parker reports an unrelated disclosure of honoraria for research and consulting for EndoGastric Solutions. Alisa Coker reports an unrelated disclosure of honoraria for research and consulting for Intuitive Surgical. Gina Adrales reports an unrelated disclosure of honoraria for research and consulting for Caresyntax, Inc., and Ethicon, Johnson & Johnson.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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