World Journal of Laparoscopic Surgery

Register      Login

VOLUME 15 , ISSUE 1 ( January-April, 2022 ) > List of Articles


A Prospective Observational Study on Single-incision or Conventional Three-port Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair

Yaser Hussain Wani, MR Attri, Ishfaq Gilkar, Safoora Wani

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

Citation Information : Wani YH, Attri M, Gilkar I, Wani S. A Prospective Observational Study on Single-incision or Conventional Three-port Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair. World J Lap Surg 2022; 15 (1):77-86.

DOI: 10.5005/jp-journals-10033-1502

License: CC BY-NC 4.0

Published Online: 13-06-2022

Copyright Statement:  Copyright © 2022; The Author(s).


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.

  1. Liu N, Greenberg JA, Brooks DC. Chapter 11: inguinal hernia. In: Maingot's abdominal operations. 13th ed. McGraw Hill Education; 2019. p. 193.
  2. Malangoni MA, Rosen MJ. Hernias. In: Sabiston textbook of surgery: the biological basis of modern surgical. 20th ed. Elsevier; 2008. p. 1092–1093.
  3. Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. Lancet 2003;362(9395):1561–1571. DOI: 10.1016/S0140-6736(03)14746-0.
  4. Hernias G. website. Available from: [Accessed May 13, 2008].
  5. Wantz GE. Abdominal wall hernias. In: Schwartz SI, editor. Principles of Surgery. 7th ed. New York, NY: McGraw-Hill; 1999. p. 1585–1611.
  6. Read RC. The contributions of Usher and others to the elimination of tension from groin herniorrhaphy. Hernia 2005;9(3):208–211. DOI: 10.1007/s10029-005-0322-1.
  7. Neumayer L, McGregor DB, Mann B. Abdominal wall, including hernia. In: Lawrence PF, editor. Essentials of general surgery. 4th ed. Baltimore, MD: Lippincott, Williams & Wilkins; 2006. p. 225–237.
  8. Wijerathne S, Agarwal N, Ramzi A, et al. Single-port versus conventional laparoscopic total extra-peritoneal inguinal hernia repair: a prospective, randomized, controlled clinical trial. Surg Endosc 2016;30(4):1356–1363. DOI: 10.1007/s00464-015-4378-4.
  9. Choi BJ, Jeong WJ, Lee IK, et al. Single-port versus conventional three-port laparoscopic totally extra peritoneal inguinal hernia repair: a randomized controlled trial. Hernia 2016;20(6):789–795. DOI: 10.1007/s10029-016-1499-1.
  10. Kim JH, Park SM, Kim JJ, et al. Initial experience of single port laparoscopic totally extraperitoneal hernia repair: nearly-scarless inguinal hernia repair. J Korean Surg Soc 2011;81(5):339–343. DOI: 10.4174/jkss.2011.81.5.339.
  11. Tai HC, Lin CD, Chung SD, et al. A comparative study of standard versus laparoendoscopic single-site surgery (LESS) totally extraperitoneal (TEP) inguinal hernia repair. Surg Endosc 2011;25(9):2879–2883. DOI: 10.1007/s00464-011-1636-y.
  12. Wijerathne S, Agarwal N, Ramzy A, et al. A prospective randomized controlled trial to compare single-port endo-laparoscopic surgery versus conventional TEP inguinal hernia repair. Surg Endosc 2014;28(11):3053–3058. DOI: 10.1007/s00464-014-3578-7.
  13. Rajapandian S, Bushan C, Sabnis SC, et al. Single incision multiport versus conventional laparoscopic inguinal hernia repair: a matched comparison. J Minim Acess Surg 2018;14(1):44–51. DOI: 10.4103/jmas.JMAS_30_17: 10.4103/jmas_30_17.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.