Comparison of Single Incision Laparoscopic Totally Extraperitoneal and Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair: Initial Experience

Background and Purpose: Laparoendoscopic single-site (LESS) surgery has been implemented recently in many laparoscopic (LAP) surgical procedures. We report our initial experience with LESS totally extraperitoneal (LESS-TEP) inguinal hernia repair in relation to conventional LAP-TEP. Patients and Methods: Between November 2008 and May 2009, 25 LESS-TEP repairs of inguinal hernia and 29 LAP-TEP repairs of inguinal hernia were performed in 44 patients. Data regarding patient demographics, type of hernia, operative time, complications, postoperative hospital stay, and recurrence were prospectively collected and analyzed. Results: All 44 patients were men, aged 17 to 84 years. Of 44 men, 3 had bilateral inguinal hernias in the LESS-TEP group and 7 in the LAP-TEP group. The operative time for bilateral LESS-TEP was 60 +/- 15.3 min (range 40-70 min) and 40 +/- 21.6 min (range 20-100 min) for unilateral LESS-TEP, while for bilateral hernia LAP-TEP it was 60 +/- 24.8 min (range 40-100 min) and for unilateral LAP-TEP it was 50 +/- 14.2 min (range 40-80 min). Comparison of operative times in the LESS-TEP and LAP-TEP groups between the first and second half cohort resulted in significant reduction of operative time in the second half of the LESS-TEP group (P < 0.001). There were no intraoperative complications. Discharge was within 72 hours for most patients in both groups. There was one early recurrence (mesh displacement) during a median follow-up period of 11.5 +/- 2.5 months in the LESS-TEP group and no recurrences during the 11 +/- 1.6 months in the LAP-TEP group. Conclusion: In our experience, LESS-TEP is a safe and feasible procedure with a short learning curve. In all analyzed parameters, it is comparable to conventional LAP-TEP. Further studies that compare LESS-TEP and conventional multiport LAP-TEP repairs with long-term follow-up evaluation are needed to confirm the initial experience.