title: Single site and conventional totally extraperitoneal techniques for uncomplicated inguinal hernia repair: A comparative study.
abstract: OBJECTIVE
  To demonstrate the feasibility of endoscopic extraperitoneal single site (EESS) inguinal hernia repair and compare it outcomes with the conventional totally extraperitoneal (TEP) technique.
  
  
  BACKGROUND
  TEP inguinal hernia repair is a widely accepted alternative to conventional open technique with several perioperative advantages. Transumbilical laparoendoscopic singlesite surgery (LESS) is an emerging approach and has been reported for a number of surgical procedures with superior aesthetic results but other advantages need to be proven.
  
  
  METHODS
  Thirty-eight uncomplicated inguinal hernias were repaired by EESS approach between January 2010 and January 2011. All procedures were performed through a 25 cm infraumbilical incision using the Alexis wound retractor attached to a surgical glove and three trocars. Body mass index, age, operative time, blood loss, complications, conversion rate, analgesia requirement, hospital stay, return to normal activities and patient satisfaction with aesthetic results were analysed and compared with the last 38 matched-pair group of patients who underwent a conventional TEP inguinal hernia repair by the same surgeon.
  
  
  RESULTS
  All procedures were performed successfully with no conversion. In both unilateral and bilateral EESS inguinal repairs, the mean operative time was longer than conventional TEP (55± 20 vs. 40± 15 min, P = 0.049 and 70± 15 vs. 55± 10 min, P = 0.014). Aesthetic result was superior in the EESS group (2.88± 0.43 vs. 2.79± 0.51, P = 0.042). There was no difference between the two approaches regarding blood loss, complications, hospital stay, time until returns to normal activities and analgesic requirement.
  
  
  CONCLUSIONS
  EESS inguinal hernia repair is safe and effective, with superior cosmetic results in the treatment of uncomplicated inguinal hernias. Other advantages of this new technique still need to be proven.
authors.affiliation: Urologic Department, Faculdade de Medicina do ABC, Santo Andre, SP, Brazil.
authors.forename: Felipe Brandão Corrêa
authors.initials: FB
authors.lastname: de Araújo
authors.affiliation: Urologic Department, Faculdade de Medicina do ABC, Santo Andre, SP, Brazil.
authors.forename: Eduardo Simão
authors.initials: ES
authors.lastname: Starling
authors.affiliation: General Surgery Department, Mayo Clinic, Rochester, Minnesota, United States.
authors.forename: Marco
authors.initials: M
authors.lastname: Maricevich
authors.affiliation: Urologic Department, Faculdade de Medicina do ABC, Santo Andre, SP, Brazil.
authors.forename: Marcos
authors.initials: M
authors.lastname: Tobias-Machado
keywords: Inguinal hernia; LESS; laparoscopic; single site surgery