Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK.
Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK.
Int J Surg. 2016 May;29:25-35. doi: 10.1016/j.ijsu.2016.02.088. Epub 2016 Mar 11.
The objective of this article is to evaluate whether the surgical outcomes differ between single incision laparoscopic surgery (SILS) versus multi-incision laparoscopic surgery (MILS) for the repair of inguinal hernia.
A systematic review of the literature on published studies reporting the surgical outcomes following SILS versus MILS for inguinal hernia repair was undertaken using the principles of meta-analysis.
Fifteen comparative studies on 1651 patients evaluating the surgical outcomes in patients undergoing SILS versus MILS for inguinal hernia repair were systematically analysed. The post-operative recovery time was significantly quicker [odds ratio, -0.35 (CI, -0.57 - 0.14), p = 0.001] following SILS compared to MILS procedure. However, the statistical equivalence was seen in outcomes of length of hospital stay, operative time both for unilateral and bilateral hernias, post-operative pain score, one-week pain score, hernia recurrence [odds ratio, 1.24 (CI, 0.47-3.23), p = 0.66], conversion [odds ratio, 1.07 (CI, 0.37-3.12), p = 0.90], and post-operative complications [odds ratio, 0.95 (CI, 0.66-1.36, p = 0.78] between two approaches. The sub-group analysis of four included randomized, controlled trials showed similarities between outcomes following SILS and MILS except slightly higher postoperative pain score in MILS group.
Both SILS and MILS approaches of inguinal hernia repair are feasible, safe and can be offered to patients depending upon the availability of expertise and resources.
本文旨在评估单切口腹腔镜手术（SILS）与多切口腹腔镜手术（MILS）治疗腹股沟疝的手术效果是否存在差异。
采用荟萃分析的原则，对报道 SILS 与 MILS 治疗腹股沟疝修补术后手术效果的已发表研究进行了系统评价。
系统分析了 15 项比较 SILS 与 MILS 治疗腹股沟疝修补术患者手术效果的前瞻性研究，共纳入 1651 例患者。与 MILS 组相比，SILS 组术后恢复时间明显更快[比值比（OR）：-0.35（95%置信区间（CI）：-0.57 至-0.14），p=0.001]。然而，在住院时间、单侧和双侧疝的手术时间、术后疼痛评分、术后 1 周疼痛评分、疝复发率[OR：1.24（95%CI：0.47-3.23），p=0.66]、中转开腹率[OR：1.07（95%CI：0.37-3.12），p=0.90]和术后并发症发生率[OR：0.95（95%CI：0.66-1.36），p=0.78]方面，两种方法的结果均具有统计学等效性。纳入的 4 项随机对照试验的亚组分析结果显示，SILS 和 MILS 两种方法治疗腹股沟疝的结果相似，仅 MILS 组术后疼痛评分略高。
SILS 和 MILS 两种方法治疗腹股沟疝均可行、安全，可根据专业技术和资源的可用性选择应用。
