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Single-incision laparoscopic surgery through the umbilicus is associated with a higher incidence of trocar-site hernia than conventional laparoscopy: a meta-analysis of randomized controlled trials

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Abstract

Background

Single-incision laparoscopic surgery has been developed with the objective to reduce surgical trauma, decrease associated surgical stress and to improve cosmetic outcome. However, concerns have been raised regarding the risk of trocar-site hernia following this approach. Previous meta-analyses have suggested a trend toward higher hernia rates, but have failed to demonstrate a significant difference between single-incision and conventional laparoscopic surgery.

Method

Medline, AMED, CINAHL and CENTRAL were searched up to May 2014. Randomized controlled trials comparing single-incision and conventional laparoscopic surgery were considered for inclusion. Studies with patients aged less than 18 years and those reporting on robotic surgery were disregarded. Pooled odds ratios with 95 % confidence intervals were calculated to measure the comparative risk of trocar-site hernia following single-incision and conventional laparoscopic surgery.

Results

Nineteen randomized trials encompassing 1705 patients were included. Trocar-site hernia occurred in 2.2 % of patients in the single-incision group and in 0.7 % of patients in the conventional laparoscopic surgery group (odds ratio 2.26, 95 % confidence interval 1.00–5.08, p = 0.05). Sensitivity analysis of quality randomized trials validated the outcome estimates of the primary analysis. There was no heterogeneity among studies (I 2 = 0 %) and no evidence of publication bias.

Conclusion

Single-incision laparoscopic surgery involving entry into the peritoneal cavity through the umbilicus is associated with a slightly higher risk of trocar-site hernia than conventional laparoscopy. Its effect on long-term morbidity and quality of life is a matter for further investigation.

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Acknowledgments

The authors wish to thank Dr. Alexandros Andreou for translation of articles from the Spanish language. The contribution of Ms. Angeliki Zachou, clinical librarian at the Papageorgiou University Hospital of Thessaloniki is greatly acknowledged.

Conflict of interest

SAA declares no conflict of interest. SMC declares no conflict of interest. GAA declares no conflicts of interest. FAA declares no conflict of interest. FB declares conflict of interest not directly related to the submitted work. FEM declares conflict of interest not directly related to the submitted work. ACB declares conflict of interest not directly related to the submitted work. KB declares no conflict of interest. MLC declares conflict of interest not directly related to the submitted work. DC declares conflict of interest not directly related to the submitted work. EBD declares conflict of interest not directly related to the submitted work. BEE declares no conflict of interest. RHF declares conflict of interest not directly related to the submitted work. JFG declares conflict of interest not directly related to the submitted work. NAH declares no conflict of interest. MM declares conflict of interest not directly related to the submitted work. DLS declares conflict of interest not directly related to the submitted work. MPS declares no conflict of interest. LV declares no conflict of interest.

Author information

Authors and Affiliations

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

    S. A. Antoniou & F. A. Granderath

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

    S. A. Antoniou

  3. Unidad de Gestión Clínica de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen Del Rocío, Sevilla, Spain

    S. Morales-Conde

  4. Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK

    G. A. Antoniou

  5. Department of General and Hepatobiliary Surgery and Liver Transplantation Service, Ghent University Hospital and Medical School, Ghent, Belgium

    F. Berrevoet

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

    F. E. Muysoms

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

    S. A. Antoniou

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  1. S. A. Antoniou
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  4. F. A. Granderath
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Consortia

The Bonham Group

  • Andrew C. de Beaux
  • , Kamil Bury
  • , Manuel Lopez-Cano
  • , Diego Cuccurullo
  • , Eva B. Deerenberg
  • , Barbora E. East
  • , Rene H. Fortelny
  • , Jean-Francois Gillion
  • , Nadia A. Henriksen
  • , Marc Miserez
  • , David L. Sanders
  • , Maarten P. Simons
  •  & Linas Venclauskas

Corresponding author

Correspondence to S. A. Antoniou.

Additional information

Members of the Bonham Group are listed in “Appendix 1”.

Appendices

Appendix 1

“The Bonham Group” is the European Hernia Society Guidelines Development Group for Guidelines on the closure of abdominal wall incisions:

Andrew C. de Beaux

Kamil Bury

Manuel Lopez-Cano

Diego Cuccurullo

Eva B. Deerenberg

Barbora E. East

Rene H. Fortelny

Jean-Francois Gillion

Nadia A. Henriksen

Marc Miserez

David L. Sanders

Maarten P. Simons

Linas Venclauskas

Appendix 2: Search strategy

1. Hernia

2. Incisional hernia

3. Trocar-site hernia

4. Trocar site hernia

5. Port-site hernia

6. Port site hernia

7. Single-incision

8. Single incision

9. Single-port

10. Single port

11. Single-access

12. Single access

13. One-access

14. One access

15. One-port

16. One port

17. Single-site

18. Single site

19. Laparoscopy

20. Laparoscopic

21. 1 OR 2 OR 3 OR 4 OR 5 OR 6

22. 7 OR 8 OR 9 OR 10 OR 11 OR 12 OR 13 OR 14 OR 15 OR 16 OR 17 OR 18

23. 19 OR 20

Search terms combination: 21 AND 22 AND 23

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Antoniou, S.A., Morales-Conde, S., Antoniou, G.A. et al. Single-incision laparoscopic surgery through the umbilicus is associated with a higher incidence of trocar-site hernia than conventional laparoscopy: a meta-analysis of randomized controlled trials. Hernia 20, 1–10 (2016). https://doi.org/10.1007/s10029-015-1371-8

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  • DOI: https://doi.org/10.1007/s10029-015-1371-8

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