Single-incision surgery and trocar-site hernia: A systematic review and meta-analysis with trial sequential analysis

Author(s): Hajibandeh S.; Garcia-Alamino J.; Weitzendorfer M.; Emmanuel K.; Muysoms F.; Granderath F.; Chalkiadakis G.; Antoniou S.; Antoniou G.; Gioumidou M.; Iliopoulou-Kosmadaki S.; Mathioudaki M.; Souliotis K.

Source: Surgical Endoscopy and Other Interventional Techniques; Jun 2017; vol. 31 (no. 2)

Publication Date: Jun 2017

Publication Type(s): Conference Abstract

Abstract:Aim: Single-incision laparoscopic surgery (SILS) is a novel concept, aiming at further minimizing abdominal wall trauma and improving cosmesis. Concerns have been raised about the risk of trocar site hernia following SILS. This study aims at assessing the comparative risk of trocar site hernia following SILS and conventional laparo-scopic surgery, and investigating whether current evidence is conclusive. Methods: We performed a systematic search of Medline, AMED, CINAHL, CENTRAL and OpenGrey. Randomized clinical trials of SILS and conventional laparoscopic surgery providing trocar-site hernia rates were considered for inclusion. Pooled odds ratios with 95% confidence intervals were calculated using the Mantel Haenszel method. Trial sequential analysis with the Land and DeMets approach was performed to assess the possibility of type I error and to compute the information size. Results: Twenty-three articles reporting on 2471 patients were included. SILS was associated with higher odds of trocar-site hernia compared to conventional laparoscopic surgery (odds ratio 2.37, 95% confidence interval 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 alpha-spending boundaries at 1137 patients, which suggests that the evidence of higher risk of trocar-site hernia following SILS compared to conventional laparoscopic surgery can be considered conclusive. Conclusion: 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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Database: EMBASE