Page 79 - World Journal of Laparoscopic Surgery

RESEARCH ARTICLE
A Prospective Observational Study on Single-incision or

Conventional Three-port Laparoscopic Totally Extraperitoneal

Inguinal Hernia Repair

1
2
3
Yaser Hussain Wani , MR Attri , Ishfaq Gilkar , Safoora Wani 4
AbstrAct
Aim: The study was aimed to describe the outcome of single-incision laparoscopic surgery (SILS) and conventional totally extraperitoneal
(CTEP) repair for inguinal hernias in terms of the following: (i) operative time; (ii) rate of conversion to open; (iii) postoperative complications;
(iv) hospital stay; (v) cost; (vi) time until return to normal daily work; (vii) postoperative pain score; and (viii) cosmesis.
Materials and methods: The present study was a prospective observational study done at the Government Medical College Srinagar, Department
of surgery and allied super specialities.
Results: The mean operating time in the CTEP group was 41.2 and 42.8 minutes for SILS TEP. Overall complications were slightly more in CTEP.
The mean postoperative hospital stay was 19.2 and 21.8 hours in CTEP and SILS TEP, respectively. The average time to resume normal work
was 3.7 ± 0.8 days in CTEP repair and 3.3 ± 1.2 days in SILS TEP repair. The mean visual analogue scale score at 6 hours in the CTEP group was
3.1 ± 2.8 and in the SILS TEP group 2.8 ± 0.8. The mean cosmetic result was 4.1 ± 0.9 in the SILS TEP group.
Conclusion: Laparoscopic repair of inguinal hernias is associated with good results in both techniques. SILS TEP inguinal hernia repair using
conventional laparoscopic instruments is a safe and feasible alternative to CTEP in experienced hands. The outcomes of SILS TEP for operation
time, postoperative complication, hospital stay, time until return to normal activity, and rate of conversion to open are comparable to CTEP.
However, the approach provided an advantage in terms of cosmesis and postoperative pain.
Clinical significance: SILS TEP although having a learning curve and difficult to use in large/complete groin hernias is a good technique for use
in small hernias using routine laparoscopic instruments in a resource-limited setting with significant outcome in terms of cosmesis.
Keywords: Hernia, Intraperitoneal onlay mesh, Laparoscopic, Laparoscopic hernia repair, Mesh, Mesh repair, Single-incision laparoscopic surgery,
Single-port, Single-port access surgery, Totally extraperitoneal, Transabdominal retromuscular, Ventral.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1502

IntroductIon 1 Department of General Surgery and Allied Superspecialities,
1
The word “hernia” is derived from the Latin term meaning “rupture.” Government Medical College, Srinagar, Jammu and Kashmir, India
Hernia is defined as an abnormal protrusion of an organ or tissue 2–4 Department of Surgery, Government Medical College, Srinagar,
through a defect in its surrounding walls. Hernia can occur at various Jammu and Kashmir, India
sites of the body, most commonly involving the abdominal wall, Corresponding Author: Safoora Wani, Department of Surgery,
particularly the inguinal region. The most common sites are the Government Medical College, Srinagar, Jammu and Kashmir, India,
inguinal, femoral, and umbilical areas, linea alba, lower portion of Phone: +91 9697901442, e-mail: safoorawani@gmail.com
the semilunar line, and previous incisions sites. Strangulation is the How to cite this article: Wani YH, Attri MR, Gilkar I, et al. A Prospective
most common as well as serious complication of hernia and is seen Observational Study on Single-incision or Conventional Three-port
in only 1–3% of groin hernias. 2 Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair. World
Inguinal hernias account for 75% of abdominal wall hernias, J Lap Surg 2022;15(1):77–86.
3
with a lifetime risk of 27% in men and 3% in women. Inguinal Source of support: Nil
hernias are classified as direct or indirect based upon the site Conflict of interest: None
of herniation relative to surrounding structures. The definitive
treatment of inguinal hernias is surgical repair.
Over the past century, multiple methods of repair have been used.
The goals of herniorrhaphy include the following: The techniques have progressed from open repair to laparoscopic
• Minimizing operative and postoperative discomfort for the approaches.
patient. Over the last few years, with increasing demand of better
• Achieving an effective repair, cosmetic results along with better surgical outcome, a newer
• Ensuring the lowest possible recurrence rate, technique has gained interest among the surgeons. In 2009, the
• Permitting a rapid return to normal activities, and first case of single-incision totally extraperitoneal inguinal hernia
4
• Performing a cost-effective procedure. repair was reported. However, evaluating this newer technique

© The Author(s). 2022 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.