To compare the efficacy and safety of single-incision laparoscopic totally extra-peritoneal hernia repair (SIL-TEP) and conventional three-port laparoscopic totally extra-peritoneal hernia repair (CL-TEP).

PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database and VIP Journal Database were searched from the establishment of the databases to July 2024, for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing SIL-TEP with CL-TEP. Two reviewers independently performed literature screening, data extraction and quality assessment according to the inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.4 and Stata 18.0 MP.

A total of 28 studies were included, comprising 10 RCTs and 18 CCTs, involving 2939 patients (1542 in the SIL-TEP group and 1397 in the CL-TEP group). There were no statistically significant differences in age or body mass index between the two groups (P>0.05). The SIL-TEP group had a longer operation time for unilateral hernias (MD=6.22, 95% CI 2.07-10.37; P=0.003); and a longer operation time for bilateral hernias after excluding two studies contributing to heterogeneity (MD=7.88, 95% CI 4.08-11.69; P<0.0001), but the difference was not statistically significant when all studies were included (P=0.08). The SIL-TEP group also had a higher incision satisfaction score (SMD=0.21, 95% CI 0.03-0.39; P=0.02), a lower pain score at 24 h after surgery (SMD=-0.59, 95% CI -0.93--0.26; P=0.0005), and a lower incidence of postoperative subcutaneous emphysema (RR=0.20, 95% CI 0.04-0.99; P=0.05; reported in only two studies). There were no significant differences in intraoperative blood loss, postoperative hospital stays, time to return to normal activities or the incidence of postoperative complications between the two groups (all P>0.05).

Compared with CL-TEP, SIL-TEP has comparable safety and feasibility, with less postoperative pain, better incision cosmesis, and the incidence of subcutaneous emphysema may be lower. However, it requires a longer operation time for unilateral hernias, and operation time may also be prolonged for bilateral hernias. SIL-TEP may be chosen for patients with uncomplicated hernias who have high demands regarding cosmesis and pain relief. It should be chosen with caution when the operation time needs to be controlled, such as in elderly patients or those with complex hernias.