The role of the laparoendoscopic single site totally extraperitoneal approach to inguinal hernia repairs: a review and meta-analysis of the literature

Autor: Shaun R. Preston, Muhammad R. S. Siddiqui, Steven J Brennan, Y Soon, Oliver H. Priest, Maksym Kovzel
Rok vydání: 2014
Předmět:
Zdroj: Canadian Journal of Surgery. 57:116-126
ISSN: 1488-2310
0008-428X
DOI: 10.1503/cjs.010612
Popis: Inguinal hernias are a common problem and concern in the population with more than 80 000 new diagnoses1 leading to more than 70 000 repairs between 2010 and 2011 in the UK;2 20 million repairs are performed worldwide every year.3,4 Open inguinal hernia repairs are well-established procedures5 with good postoperative outcomes. Since the early 1990s6,7 laparoscopic techniques have become more popular. Some studies report an increase from 6% in 1992 to more than 40% in 2008 of hernias being repaired laparoscopically;8 this rapid rise in use may be because of less pain, faster recovery and better long-term outcomes.9–11 Furthermore, the minimally invasive procedures (typically the transperitoneal approach, but also the extraperitoneal approach if the midline raphe is crossed) offer the ability to examine the contralateral side,12 which may reveal an incipient or obvious hernia in up to 20% of patients.13,14 The proportion of laparosopic repairs has increased markedly over the last 20 years.15 The 2 recognized types of laparoscopic approaches are totally extraperitoneal preperitoneal (TEPP) or transabdominal preperitoneal (TAPP). Although both techniques are safe16 and offer advantages, totally extraperitoneal (TEP) repairs may be associated with a lower incidence of port site hernias, bowel-related complications, less pain and greater patient satisfaction; conversely, TEP may be associated with an increased likelihood of conversion.17–19 Greater patient education and demand for better cosmesis after surgical procedures have led to increased interest in laparoendoscopic single site surgery (LESS). Initially there was reluctance to adopt the technique owing to lack of technical facilitation; however, new or innovative port types20 and newer instruments have led to its application in a variety of surgical specialities.21 Laparoendoscopic single site TEP may be performed using conventional instruments, although articulating or curved instruments are in use.22 Although patients have good outcomes after conventional laparoscopic techniques, some authors suggest that there is a preference for LESS,23 which may be because of less postoperative pain24,25 or possible better cosmesis. Some have argued there is no advantage to single port surgery.26 We hypothesized that LESS TEP may be superior to conventional laparoscopic TEP (LAP TEP) because of fewer incisions, which may lead to less pain, and because the single incision in the umbilicus may result in a hidden scar with a better cosmetic appearance. We reviewed the literature examining the role of LESS TEP for inguinal hernias. We aimed to compare LESS TEP with LAP TEP. Our main summative outcome measures were duration of surgery, hospital stay, cosmesis and return to activity.
Databáze: OpenAIRE
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