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Single-incision surgery trocar-site hernia: an updated systematic review meta-analysis with trial sequential analysis by the Minimally Invasive Surgery Synthesis of Interventions Outcomes Network (MISSION)

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Abstract

Background

Single-incision laparoscopic surgery (SILS) is a new technique that aims to minimize abdominal wall trauma and improve cosmesis. Concerns have been raised about the risk of trocar-site hernia following SILS. This study aims to assess the risk of trocar-site hernia following SILS compared to conventional laparoscopic surgery, and investigate whether current evidence is conclusive.

Methods

We performed a systematic search of MEDLINE, AMED, CINAHL, CENTRAL, and OpenGrey. We considered randomized clinical trials comparing the risk of trocar-site hernia with SILS and conventional laparoscopic surgery. Pooled odds ratios with 95% confidence intervals (CI) were calculated using the Mantel–Haenszel method. Trial sequential analysis using the Land and DeMets method was performed to assess the possibility of type I error and compute the information size.

Results

Twenty-three articles reporting a total of 2471 patients were included. SILS was associated with higher odds of trocar-site hernia compared to conventional laparoscopic surgery (odds ratio 2.37, 95% CI 1.25–4.50, p = 0.008). There was no evidence of between-study heterogeneity or small-study effects. The information size was calculated at 1687 patients and the Z-curve crossed the O’Brien–Fleming α-spending boundaries at 1137 patients, suggesting that the evidence of higher risk of trocar-site hernia with SILS compared to conventional laparoscopic surgery can be considered conclusive.

Conclusions

Single-incision laparoscopic procedures through the umbilicus are associated with a higher risk of trocar-site hernia compared to conventional laparoscopic surgery.

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Authors and Affiliations

  1. Department of General Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece

    Stavros A. Antoniou & George E. Chalkiadakis

  2. Center for Minimally Invasive Surgery, Neuwerk Hospital, Mönchengladbach, Germany

    Stavros A. Antoniou & Frank A. Granderath

  3. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK

    Josep M. García-Alamino

  4. Department of General Surgery, Royal Blackburn Hospital, Blackburn, UK

    Shahab Hajibandeh & Shahin Hajibandeh

  5. Department of Surgery, Paracelsus Medical University, Salzburg, Austria

    Michael Weitzendorfer & Klaus Emmanuel

  6. Department of Surgery, AZ Maria Middelares, Ghent, Belgium

    Filip E. Muysoms

  7. Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK

    George A. Antoniou

  8. School of Medicine, University of Crete, Heraklion, Crete, Greece

    Meropi Gioumidou, Styliani Iliopoulou-Kosmadaki, Maria Mathioudaki & Kyriakos Souliotis

  9. Athinon-Souniou 11, Keratea Attikis, 19001, Athens, Greece

    Stavros A. Antoniou

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  1. Stavros A. Antoniou
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Correspondence to Stavros A. Antoniou.

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Disclosures

Stavros A. Antoniou and Filip E. Muysoms were members of the Guidelines Committee of the European Hernia Society on the Closure of Abdominal Wall Incisions. They have no other conflicts of interest or financial ties to disclose. Josep M García-Alamino, Shahab Hajibandeh, Shahin Hajibandeh, Michael Weitzendorfer, Frank A. Granderath, George E. Chalkiadakis, Klaus Emmanuel, George A. Antoniou, Meropi Gioumidou, Styliani Iliopoulou-Kosmadaki, Maria Mathioudaki and Kyriakos Souliotis have no conflicts of interest or financial ties to disclose.

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Antoniou, S.A., García-Alamino, J.M., Hajibandeh, S. et al. Single-incision surgery trocar-site hernia: an updated systematic review meta-analysis with trial sequential analysis by the Minimally Invasive Surgery Synthesis of Interventions Outcomes Network (MISSION). Surg Endosc 32, 14–23 (2018). https://doi.org/10.1007/s00464-017-5717-4

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