Single-port versus multi-port totally extraperitoneal (TEP) inguinal hernia repair: A meta-analysis of randomized controlled trials

Abstract

Background:The value of single-port totally extraperitoneal inguinal hernia repair (STEP) when compared to the conventional multi-port approach (TEP) is still a matter of controversy. We conducted a meta-analysis of randomized controlled trials comparing the feasibility and safety of the above-mentioned techniques.Methods: A systematic literature search for randomized controlled trials (RCTs) comparing the outcome STEP and TEP in patients with inguinal hernia was conducted. Data regarding postoperative outcomes were extracted and compared by metaanalysis. The Odds Ratio and Standardized Mean Differences with 95% Confidence Intervals (CI) were calculated.Results: Six RCTs were identified, involving a total of 636 cases (STEP: n = 328, TEP: n = 308). There was a statistically significant difference noted between the 2 groups regarding return to everyday activities favoring the STEP group (SMD = −0.23; 95% CI [−0.41, −0.06]; P = .01; 4 studies; I 2 = 9). For the remaining primary and secondary endpoints, intra-and postoperative morbidity, conversion rate, peritoneal tears, major intraoperative bleeding, postoperative haematoseroma, operative time, postoperative pain, chronic pain, cosmetic satisfaction, hernia recurrence and in-hospital length of stay no statistically significant difference was noted between the 2 study groups.Conclusions: Current evidence suggests that patients who underwent STEP had similar outcomes to the traditional TEP technique with the exception of time to return to everyday activities, which was reported to be shorter in the STEP group.Abbreviations: CI = confidence interval, OR = odds ratio, RCT = randomized controlled trial, SMD = standard mean difference, STEP = single-port totally extraperitoneal hernia repair, TEP = totally extraperitoneal hernia repair.