Comparison of single-incision totally extraperitoneal repair of inguinal hernia and conventional multi-port totally extraperitoneal repair: A retrospective study

Introduction: Mesh-based repair is the standard treatment of inguinal hernias. Transabdominal preperitoneal repair and totally extraperitoneal (TEP) repair are the established laparoendoscopic techniques. Although TEP avoids intra-abdominal access, technical difficulty limits its adoption. Single-incision laparoscopic surgery (SILS) offers cosmetic and potential clinical advantages. However, evidence comparing SILS-TEP with conventional three-port TEP remains limited. This study aimed to evaluate the feasibility, safety and clinical outcomes of SILS-TEP compared with those of three-port TEP for inguinal hernia repair. Patients and Methods: We retrospectively reviewed adult patients who underwent TEP hernia repair at our institute between April 2022 and June 2025. Patients were divided into SILS-TEP and three-port TEP groups. Demographics, hernia classification, operative details, pain, complications and recovery outcomes were analysed. Acute pain was assessed by post-operative analgesic use and chronic pain was defined as pain persisting for more than 3 months. Statistical significance was set at P < 0.05. Results: A total of 102 patients (62 SILS-TEP, 40 3-port TEP) were evaluated. Patient characteristics and hernia types were similar between the groups. The operative time was significantly shorter in the SILS-TEP group than in the three-port TEP group (57.4 min vs. 70.3 min, P = 0.007). No differences were observed in analgesic use, complications or hospitalisation. No conversions, chronic pain or hernia recurrence were reported in either group. Conclusion: SILS-TEP was safely performed without compromising surgical quality. It demonstrated a shorter operative time and equivalent clinical outcomes compared to three-port TEP. SILS-TEP may be a feasible and cosmetically superior alternative for inguinal hernia repair.