Purpose: This study describes our preliminary experience of a single incisional laparoscopic totally extraperitoneal approach (TEP) for inguinal hernia repair, compared to conventional TEP. Methods: From August 2012 to February 2014, 46 patients underwent inguinal hernia repair using a laparoscopic totally extraperitoneal approach by a single surgeon at Hansol Hospital, Seoul, Korea. Three patients were excluded due to a recurrent inguinal hernia; thus, 43 patients were enrolled in two groups, the single incisional TEP (STEP) group (n=23) and the conventional TEP (CTEP) group (n=20). The mean follow-up period was 15 months. Results: No differences in patient demographics (age, sex, hernia site and type, and body mass index) were detected between the two groups. The operation time in the STEP group was significantly longer than that in the CTEP group (69.7±28.5 vs. 51.0±16.4 min, p=0.017). No differences in postoperative complications were detected, including chronic pain, voiding difficulties, or the occurrence of a wound seroma (STEP, n=3 vs. CTEP, n=2). Pain scores (STEP, 1.4±0.7 vs. CTEP 1.4±0.8) and hospital stay duration (STEP, 1.0±0.2 vs. CTEP, 1.2±0.5 days) also did not differ between the groups. No patient in the STEP group required an additional port. Conclusion: Single incisional TEP was technically feasible, although it required a longer operation time. STEP appeared to have better cosmetic results compared with those of CTEP.

Keywords Inguinal hernia, Herniorrhaphy, Laparoscopy

1. Lichtenstein IL, Shulman AG, Amid PK, Montllor MM. The tension-free hernioplasty. Am J Surg 1989;157:188-193.
   
2. McCormack K, Wake BL, Fraser C, Vale L, Perez J, Grant A. Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair: a systematic review. Hernia 2005;9:109-114.
   
3. Bittner R, Montgomery MA, Arregui E, et al. Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society). Surg Endosc 2015;29:289-321.
   
4. Lau H, Patil NG, Yuen WK. Day-case endoscopic totally extraperitoneal inguinal hernioplasty versus open Lichtenstein hernioplasty for unilateral primary inguinal hernia in males: a randomized trial. Surg Endosc 2006;20:76-81.
   
5. McCormack K, Wake B, Perez J, et al. Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation. Health Technol Assess 2005;9:1-203, iii-iv.
   
6. Pelosi MA, Pelosi MA, 3rd. Laparoscopic supracervical hysterectomy using a single-umbilical puncture (minilaparoscopy). J Reprod Med 1992;37:777-784.
   
7. Sodergren MH, Aslanyan A, McGregor CG, et al. Pain, wellbeing, body image and cosmesis: a comparison of single-port and four-port laparoscopic cholecystectomy. Minim Invasive Ther Allied Technol 2014;23:223-229.
   
8. Choi BJ, Lee KJ, Lee SC. Direct application of single-port laparoscopic totally extraperitoneal (TEP) inguinal hernia repair by an experienced single-port laparoscopic surgeon who was inexperienced in conventional TEP hernia repair: initial experience with 100 cases. J Laparoendosc Adv Surg Tech A 2014;24:333-338.
   
9. Wijerathne S, Agarwal N, Ramzy A, Lomanto D. A prospective randomized controlled trial to compare single-port endolaparoscopic surgery versus conventional TEP inguinal hernia repair. Surg Endosc 2014;28:3053-3058.
   
10. Cheng Y, Jiang ZS, Xu XP, et al. Laparoendoscopic single-site cholecystectomy vs three-port laparoscopic cholecystectomy: a large-scale retrospective study. World J Gastroenterol 2013;19:4209-4213.
    
11. Agrawal S, Shaw A, Soon Y. Single-port laparoscopic totally extraperitoneal inguinal hernia repair with the TriPort system:initial experience. Surg Endosc 2010;24:952-956.
    
12. Kim JH, Lee YS, Kim JJ, Park SM. Single port laparoscopic totally extraperitoneal hernioplasty: a comparative study of short-term outcome with conventional laparoscopic totally extraperitoneal hernioplasty. World J Surg 2013;37:746-751.
    
13. Tai HC, Lin CD, Chung SD, Chueh SC, Tsai YC, Yang SS. A comparative study of standard versus laparoendoscopic singlesite surgery (LESS) totally extraperitoneal (TEP) inguinal hernia repair. Surg Endosc 2011;25:2879-2883.
    
14. Bringman S, Wollert S, Osterberg J, Smedberg S, Granlund H, Heikkinen TJ. Three-year results of a randomized clinical trial of lightweight or standard polypropylene mesh in Lichtenstein repair of primary inguinal hernia. Br J Surg 2006;93:1056-1059.
    
15. Lau H. Fibrin sealant versus mechanical stapling for mesh fixation during endoscopic extraperitoneal inguinal hernioplasty: a randomized prospective trial. Ann Surg 2005;242:670-675.
    
16. Yang GP, Tung KL. A comparative study of single incision versus conventional laparoscopic inguinal hernia repair. Hernia 2014.