Sharon Monsivais, BA, Hannah Vassaur, MS, PAC, Nicole E Sharp, MD, John Eckford, MD, Rob Watson, MD, Daniel Jupiter, PhD, F. Paul Buckley III, MD
Division of General Surgery, Scott and White Healthcare
Purpose: A retrospective chart review comparing single-incision laparoscopic (SILS) inguinal hernia repair and traditional 3-port laparoscopic (LAP) inguinal hernia repair was conducted to assess the safety and feasibility of the minimally invasive laparoscopic technique.
Methods: All SILS and LAP inguinal hernia repairs performed by three surgeons at a single institution between August 1, 2008 and July 30, 2012 were reviewed. Statistical evaluation included descriptive analysis of demographic data including age, gender, BMI, and hernia location (unilateral or bilateral) in addition to bivariate analyses of operative outcomes including operative times, conversions to open, case complexity and complications.
Results: 129 patients who underwent SILS inguinal hernia repair and 76 who underwent LAP inguinal hernia repair were compared. Cases included 92.68% men with a mean age of 55.36 (range 8-86) and a mean BMI of 26.49 (range 17.3-41.7); there were no significant differences in these variables between SILS and LAP cases. A one sided t-test for superiority indicated that average operative time for SILS unilateral cases was statistically significantly shorter than for LAP unilateral cases (57.51 versus 66.96 minutes; p=0.043). For bilateral cases, average operative time for SILS and LAP were similar (81.07 versus 81.38 minutes), but a t-test for non-inferiority, with a non-inferiority margin of five minutes, was not statistically significant (p-value=0.18). In a linear model for operative time including the covariates surgery type, BMI, case complexity, and hernia location, an increase of 1 kg/m2 in BMI increased operative time by 1.33 minutes on average, which was statistically significant. Bilateral cases also took an average of 21.5 minutes longer than unilateral cases, also significant. The presence of an incarcerated or recurrent hernia also proved to be a significant factor, showing an average increase in operative length of 9.23 minutes. Using this model, a test for non-inferiority showed that the SILS technique took no more than five minutes longer than the LAP technique (p-value=0.031). There were no conversions from SILS to multiport technique, but five (3.88%) SILS and three (3.95%) LAP cases were converted to either Kugel or Lichtenstein repairs; this was not a significant difference in conversion rate (Fisher exact p-value 1). Additionally, there was no significant difference in complication rates between SILS and LAP (chi-squared p-value 0.65).
Conclusion: SILS inguinal hernia repair is both a safe and feasible alternative to traditional LAP inguinal hernia repair and can be successfully conducted with similar operative times, conversion rates and complication rates. This comparative study will serve as a starting point for prospective trials, which are essential to confirming equivalence in these areas as well as revealing differences in patient satisfaction with post-operative pain, cosmesis, and quality of life.
Session: Podium Presentation
Program Number: S017