Surgical Endoscopy

, 25:2879 | Cite as

A comparative study of standard versus laparoendoscopic single-site surgery (LESS) totally extraperitoneal (TEP) inguinal hernia repair

  • Huai-Ching Tai
  • Chia-Da Lin
  • Shiu-Dong Chung
  • Shih-Chieh Jeff Chueh
  • Yao-Chou Tsai
  • Stephen Shei-Dei Yang



Laparoscopic inguinal hernia repair has been around since the 1990s. A novel surgical approach known as laparoendoscopic single-site surgery (LESS) has been developed to reduce the port-related morbidities and improve the cosmetic outcomes of laparoscopic surgery, including totally extraperitoneal (TEP) inguinal hernia repair. The aim of the present study was to evaluate the safety and feasibility of the LESS TEP technique for inguinal hernia repair and compare the outcomes with the standard TEP approach.


Between January and May 2009, 54 consecutive healthy patients (48 men and 6 women) underwent LESS TEP inguinal hernia repair at our institute. All procedures were performed using our homemade single port for simultaneous passage of the laparoscope and instruments. The perioperative data, including patient age, sex, body mass index (BMI), hernia characteristics, operative time, complications, length of hospital stay, return to normal activity, pain score, and cosmetic result, were prospectively collected.


All LESS TEP procedures were completed successfully without conversion to standard laparoscopic or open surgery. A total of 98 LESS TEP hernia repairs were performed in 54 patients and compared with 152 standard TEP operations. The mean operative time was significantly shorter in the standard TEP series (61.8 ± 26.0 vs. 70.9 ± 23.8 min, p = 0.04). Other perioperative parameters, including the length of hospital stay, time until return to full activity, complication rate, pain score, and cosmetic result, were all comparable between the two techniques.


Our short-term experience with LESS TEP inguinal hernia repair has shown that in experienced hands, inguinal hernia repair via the LESS TEP technique is as safe as the standard TEP technique. However, based on our evidence, we currently believe that the LESS TEP technique is not an efficacious surgical alternative to the standard TEP technique for inguinal hernias.


Laparoendoscopic single-site surgery (LESS) Inguinal hernia TAPP TEP 



Huai-Ching Tai, Chia-Da Lin, Shiu-Dong Chung, Shih-Chieh Jeff Chueh, Yao-Chou Tsai, and Stephen Shei-Dei Yang have no conflicts of interest or financial ties to disclose.


  1. 1.
    Dulucq JL (1992) Treatment of inguinal hernia by insertion of a subperitoneal patch under pre-peritoneoscopy. Chirurgie 118:83–85PubMedGoogle Scholar
  2. 2.
    Kapiris SA, Brough WA, Royston CM, O’Boyle C, Sedman PC (2001) Laparoscopic transabdominal preperitoneal (TAPP) hernia repair. A 7-year two-center experience in 3017 patients. Surg Endosc 15:972–975PubMedCrossRefGoogle Scholar
  3. 3.
    Dulucq JL, Wintringer P, Mahajna A (2009) Laparoscopic totally extraperitoneal inguinal hernia repair: lessons learned from 3, 100 hernia repairs over 15 years. Surg Endosc 23:482–486PubMedCrossRefGoogle Scholar
  4. 4.
    Liem MS, van der Graaf Y, van Steensel CJ, Boelhouwer RU, Clevers GJ, Meijer WS, Stassen LP, Vente JP, Weidema WF, Schrijvers AJ, van Vroonhoven TJ (1997) Comparison of conventional anterior surgery and laparoscopic surgery for inguinal-hernia repair. N Engl J Med 336:1541–1547PubMedCrossRefGoogle Scholar
  5. 5.
    Kommu SS, Chakravarti A, Luscombe CJ, Golash A, Desai MM, Kaouk JH, Gill IS, Cadeddu JA, Rané A (2009) Laparoendoscopic single-site surgery (LESS) and NOTES: standardised platforms in nomenclature. BJU Int 103:701–702PubMedCrossRefGoogle Scholar
  6. 6.
    Teixeira J, McGill K, Binenbaum S, Forrester G (2009) Laparoscopic single-site surgery for placement of an adjustable gastric band: initial experience. Surg Endosc 23(6):1409–1414PubMedCrossRefGoogle Scholar
  7. 7.
    Hong TH, You YK, Lee KH (2009) Transumbilical single-port laparoscopic cholecystectomy: Scarless cholecystectomy. Surg Endosc 23(6):1393–1397PubMedCrossRefGoogle Scholar
  8. 8.
    Castellucci SA, Curcillo PG, Ginsberg PC, Saba SC, Jaffe JS, Harmon JD (2008) Single port access adrenalectomy. J Endourol 22:1573–1576PubMedCrossRefGoogle Scholar
  9. 9.
    Aron M, Canes D, Desai MM, Haber GP, Kaouk JH, Gill IS (2009) Transumbilical single-port laparoscopic partial nephrectomy. BJU Int 103:516–521PubMedCrossRefGoogle Scholar
  10. 10.
    Rané A, Rao P, Rao P (2008) Single-port-access nephrectomy and other laparoscopic urologic procedures using a novel laparoscopic port (R-port). Urology 72:260–263PubMedCrossRefGoogle Scholar
  11. 11.
    Gill IS, Canes D, Aron M, Haber GP, Goldfarb DA, Flechner S, Desai MR, Kaouk JH, Desai MM (2008) Single port transumbilical (E-NOTES) donor nephrectomy. J Urol 180:637–641PubMedCrossRefGoogle Scholar
  12. 12.
    Tai HC, Lin CD, Wu CC, Tsai YC, Yang SS (2010) Homemade transumbilical port: an alternative access for laparoendoscopic single-site surgery (LESS). Surg Endosc 24:705–708PubMedCrossRefGoogle Scholar
  13. 13.
    Lal P, Kajla RK, Chander J, Saha R, Ramteke VK (2003) Randomized controlled study of laparoscopic total extraperitoneal versus open Lichtenstein inguinal hernia repair. Surg Endosc 17:850–856PubMedCrossRefGoogle Scholar
  14. 14.
    Garg P, Menon GR, Rajagopal M, Ismail M (2010) Laparoscopic total extraperitoneal repair of recurrent inguinal hernias. Surg Endosc 24:450–454PubMedCrossRefGoogle Scholar
  15. 15.
    Hoffman A, Leshem E, Zmora O, Nachtomi O, Shabtai M, Ayalon A, Rosin D (2010) The combined laparoscopic approach for the treatment of incarcerated inguinal hernia. Surg Endosc 24(8):1815–1818PubMedCrossRefGoogle Scholar
  16. 16.
    Staarink M, van Veen RN, Hop WC, Weidema WF (2008) A 10-year follow-up study on endoscopic total extraperitoneal repair of primary and recurrent inguinal hernia. Surg Endosc 22:1803–1806PubMedCrossRefGoogle Scholar
  17. 17.
    Ferzli G, Shapiro K, Chaudry G, Patel S (2004) Laparoscopic extraperitoneal approach to acutely incarcerated inguinal hernia. Surg Endosc 18:228–231PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Huai-Ching Tai
    • 1
    • 4
  • Chia-Da Lin
    • 1
  • Shiu-Dong Chung
    • 4
    • 5
  • Shih-Chieh Jeff Chueh
    • 4
    • 6
  • Yao-Chou Tsai
    • 1
    • 2
    • 3
  • Stephen Shei-Dei Yang
    • 1
  1. 1.Division of Urology, Department of SurgeryBuddhist Tzu Chi General HospitalTaipeiTaiwan
  2. 2.Department of UrologyMedical College of Tzu Chi UniversityHualienTaiwan
  3. 3.Institute of Biomedical EngineeringNational Taiwan UniversityTaipeiTaiwan
  4. 4.Department of UrologyNational Taiwan University Hospital and College of MedicineTaipeiTaiwan
  5. 5.Division of Urology, Department of SurgeryFar Eastern Memorial Hospital, Ban CiaoTaipeiTaiwan
  6. 6.Glickman Urological and Kidney InstituteCleveland Clinic FoundationClevelandUSA

Personalised recommendations