單孔腹腔鏡及多孔腹腔鏡疝氣手術之綜論及綜合分析
羅啟文、楊緒棣、蔡曜州、謝政興、張尚仁
台北慈濟醫院外科部泌尿科
Comparison of Laparoendoscopic Single-site versusConventional Multiple-port Laparoscopic Herniorrhaphy: a systemic review and meta-analysis
Chi-Wen Lo, Shei-Dei Yang, Yao-Chou Tsai, Cheng-Hsing Hsieh, and Shang-Jen Chang
Division of urology, Department of Surgery, Taipei Tzu-Chi Hospital, Taiwan
Purpose:
We systemically reviewed published literatures and performed meta-analysis to compare the surgical outcomes betweenLaparoendoscopic single-site over the multiple port total extraperitonealapproach in hernia repair.
Materials and Methods:
We performed a systemic search ofPubMED® and Cochrane review for all randomized controlled trials and comparative trials that compared the efficacy and safety between LESS-TEP andMP-TEP. The evaluated outcomes included perioperative parameters (operative time, conversion rate), hospital stay and complications (seroma, delay return of bladder function, post-operative pain, and recurrence). The Cochrane Collaboration Review Manager software (RevMan®, Version 5.2.6) was used for statistical analysis.
Results:
There were 10 trials met the inclusion criteria and included for meta-analysis. Totally,there were 595 and 514 patients underwent LESS-TEP and MP-TEP, respectively. The LESS-TEP took significantly longer operative time than the MP-TEP in unilateral hernia repair (weighted mean difference (WMD): 4.11 minutes, 95% CI= 0.76- 7.46, p=0.02) while not in bilateral hernia repair (WMD: 3.87 minutes, 95% of CI: -2.59~ 10.33, z=1.17, p=0.24). There were no significant differences in surgical outcomes with regard to post-operative pain scale, conversion rate, hospital stay, recurrence rate and complication rate between two groups.The length of the sub-umbilical wound was the same in both groups. The result of cosmesis was not compared because of the limited data.
Conclusion:
The current meta-analysis revealed that LESS TEP is a feasible alternative to MP-TEP in experienced hands with comparable surgical efficacy and morbidity in selected patients. Potential advantagesof LESS-TEP including better cosmesis, less post-operative pain and less trocar-associated complications were not clearly shown.