Single Incision Laparoscopic Inguinal Hernia Repair

  • Hanh Minh Tran
  • Mai Dieu Tran
  • Wayne John Hawthorne


The ability of a surgeon to maintain and update their skills is paramount to good patient care. In addition to increasing job satisfaction, mastering surgical skills is a lifelong process. Assuming that a newer procedure has a similar safety and efficacy profile to an existing procedure learning it can only increase the surgeons’ repertoire of skills which may become lifesaving in difficult cases.

Totally extraperitoneal hernia repair with single incision laparoscopic surgery (SILS) is a highly suitable alternative to conventional multiport surgery because the same infraumbilical incision can be made without additional risks of port-site hernias, and the potential damage caused by sharp trocars can be negated. The relative loss of triangulation with SILS can be easily overcome by modified dissection techniques, namely, by the use of such techniques as “chopsticks” and “in-line” dissection. With mastery of SILS and with telescopic extraperitoneal dissection, the costs of the disposables can be reduced so that SIL TEP repair becomes highly cost-effective, when compared to multiport with balloon dissection, with the potential to reduce post-op pain and analgesic intake, improved cosmesis, and early resumption of physical activities. While the potential benefits to an average patient may be minimal or modest at best, the combined effects of some 20 million patients worldwide who undergo inguinal hernia repair annually may be highly significant.

The principal author is a dedicated hernia specialist with experience of over 4000 cases of laparoscopic inguinal hernia repairs, over 16 years, with some 2000 being SIL TEP repairs undertaken since 2009. The authors have provided a step-by-step guide to SIL TEP repair with valuable tips and novel techniques to smooth out the transition from multiport to single-port surgery. Mastery of SIL TEP repair can then be applied to more difficult cases including inguino-scrotal hernias as well as ventral and incisional hernias.


Inguinal hernia Femoral hernia Single incision laparoscopic surgery Single port Totally extraperitoneal Laparoendoscopic single-site surgery 


  1. 1.
    Ger R, Monroe K, Duvivier R, Mishrick A. Management of indirect inguinal hernias by laparoscopic closure of the next of the sac. Am J Surg. 1990;159(4):370–3.CrossRefGoogle Scholar
  2. 2.
    Tran HM, Tran KH, Zajkowska M, Lam V, Hawthorne WJ. Single-port onlay mesh repair of recurrent inguinal hernias after failed anterior and laparoscopic repairs. JSLS. 2015;19(1):e2014.00212. Scholar
  3. 3.
    Stephenson BM, Kingsnorth AN. Inguinal hernioplasty using mosquito net mesh in low income countries: an alternative and cost effective prosthesis. BMJ. 2011;343:d7448. Scholar
  4. 4.
    Sanders DL, Kingsnorth AN. Prosthetic mesh materials used in hernia surgery. Expert Rev Med Devices. 2012;9(2):159–79.CrossRefGoogle Scholar
  5. 5.
    Huerta S, Varshney A, Patel PM, Mayo HG, Livingston EH. Biological mesh implants for abdominal hernia repair: US food and drug administration approval process and systematic review of its efficacy. JAMA Surg. 2016;151(4):374–81. Review.CrossRefPubMedGoogle Scholar
  6. 6.
    Kalloo AN. Natural orifice transluminal endoscopic surgery. Gastroenterol Hepatol. 2007;3(3):183–4.Google Scholar
  7. 7.
    Liu L, Chiu PW, Reddy N, Ho LK, Kitano S, Seo DW, Tajiri H, APNOTES Working Group. Natural orifice transluminal endoscopic surgery (NOTES) for clinical management of intraabdominal diseases. Dig Endosc. 2013;25(6):565–77.CrossRefGoogle Scholar
  8. 8.
    Descloux A, Pohle S, Nocito A, Keerl A. Hybrid NOTES transvaginal intraperitoneal onlay mesh in abdominal wall hernias: an alternative to traditional laparoscopic procedures. Surg Endosc. 2015;29(12):3712–6.CrossRefGoogle Scholar
  9. 9.
    Tran HM. Safety and efficacy of single incision laparoscopic surgery for total extraperitoneal inguinal hernia repair. JSLS. 2011;15(1):47–52.CrossRefGoogle Scholar
  10. 10.
    Kim JH, An CH, Lee YS, Kim HY, Lee JI. Single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP): experience of 512 procedures. Hernia. 2015;19(3):417–22.CrossRefGoogle Scholar
  11. 11.
    Evers L, Bouvy N, Branje D, Peeters A. Single-incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy: a systematic review and meta-analysis. Surg Endosc. 2016;31:3437–48. Scholar
  12. 12.
    Tsai YC, Ho CH, Tai HC, Chung SD, Chueh SC. Laparoendoscopic single-site versus conventional laparoscopic total extraperitoneal hernia repair: a prospective randomized clinical trial. Surg Endosc. 2013;27(12):4684–92.CrossRefGoogle Scholar
  13. 13.
    Tran HM, Tran K, Turingan I, Zajkowska M, Lam V, Hawthorne W. Potential benefits of single-port compared to multiport laparoscopic inguinal herniorrhaphy: a prospective randomized controlled study. Hernia. 2014;18:731–44.CrossRefGoogle Scholar
  14. 14.
    Wijerathne S, Agarwal N, Ramzy A, Lomanto D. A prospective randomized controlled trial to compare single-port endo-laparoscopic surgery versus conventional TEP inguinal hernia repair. Surg Endosc. 2014;28(11):3053–8.CrossRefGoogle Scholar
  15. 15.
    Tran HM, Tran K, Turingan I, Zajkowska M, Lam V, Hawthorne W. Single-incision laparoscopic inguinal herniorraphy with telescopic extraperitoneal dissection: technical aspects and potential benefits. Hernia. 2015;19(3):407–16.CrossRefGoogle Scholar
  16. 16.
    Lo CW, Yang SS, Tsai YC, Hsieh CH, Chang SJ. Comparison of laparoendoscopic single-site versus conventional multiple-port laparoscopic herniorrhaphy: a systemic review and meta-analysis. Hernia. 2016;20(1):21–32.CrossRefGoogle Scholar
  17. 17.
    Luo S, Wu S, Lai H, Mo X, Chen J. Single-incision laparoscopic inguinal hernioplasty versus conventional laparoscopic inguinal hernioplasty. Surg Innov. 2017;24:171–82. Scholar
  18. 18.
    Simons M, et al. International guidelines for the management of adult groin hernias. Hernia. 2017;21(6):1–181.Google Scholar
  19. 19.
    Antoniou SA, Morales-Conde S, Antoniou GA, Granderath FA, Berrevoet F, Muysoms FE, Bonham Group. Single-incision laparoscopic surgery through the umbilicus is associated with a higher incidence of trocar-site hernia than conventional laparoscopy: a meta-analysis of randomized controlled trials. Hernia. 2016;20(1):1–10.CrossRefGoogle Scholar
  20. 20.
  21. 21.
    Sherwinter DA. Transitioning to single-incision laparoscopic inguinal herniorrhaphy. JSLS. 2010;14(3):353–7.CrossRefGoogle Scholar
  22. 22.
    Tran HM, Tran KH, Zajkowska M, Lam V, Hawthorne W. Single-incision laparoscopic repair of spigelian hernias. JSLS. 2015;19(1):e2015.001644. Scholar
  23. 23.
    Tran HM, Turingan I, Zajkowska M, Tran MD. Single incision laparoscopic ventral hernia repair with suprapubic incision. JSLS. 2013;18(2):316–21.CrossRefGoogle Scholar
  24. 24.
    Tran HM. Demonstrated safety and efficacy of laparoendoscopic single-site surgery for abdominal wall hernias. JSLS. 2012;16(3):242–9.CrossRefGoogle Scholar
  25. 25.
    Tran HM, Turingan I, Zajkowska M, Tran KH. Single-port laparoscopic parastomal hernia repair with modified Sugarbaker technique. JSLS. 2014;18(1):34–40.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Hanh Minh Tran
    • 1
  • Mai Dieu Tran
    • 1
  • Wayne John Hawthorne
    • 2
  1. 1.The Sydney Hernia Specialists Clinic, Level 2SydneyAustralia
  2. 2.Sydney Medical School, The University of SydneySydneyAustralia

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