Comparison of single-incision and traditional laparoscopic surgery for the risk of incisional hernia: a systematic review and meta-analysis of randomized controlled trials.

Despite the growing popularity of single-incision laparoscopic surgery (SILS), no large-scale meta-analysis has compared the incidence of incisional hernia (IH) between SILS and traditional laparoscopic surgery (TLS).We make a meta-analysis of randomized controlled trials (RCTs) to compare the risk of IH between SILS and TLS. We searched studies in PubMed, Web of Science, and EMBASE databases for RCTs that compared SILS to TLS and reported IHs with a minimum follow-up period of 6 months. The risk of bias was assessed using the ROBINS-II tool. We used the R software to summarize and compare the incidence of IH between SILS and TLS. Additionally, we conducted subgroup analyses to explore the impact of surgical (including procedure type, incision length, incision approach, incision direction, fascia closure, and operation time) and patient factors (including BMI, age, and race) on the incidence of IH. 37 RCT studies were included in this meta-analysis. In the single-arm analysis, the incidence of IH in the SILS group was 0.7% (95% CI 0.2-1.5%), and 0.3% (95% CI 0.1-0.8%) in the TLS group. SILS does not confer an increased risk of IH, with an OR of 1.52 (95% CI 0.98-2.36) and P = 0. 57. Only variations in surgical procedures significantly influenced the incidence of IH when comparing SILS and TLS. Our study did not demonstrate a statistically significant difference in the incidence of IH between the SILS and TLS groups. Therefore, SILS is a viable alternative for patients who require minimally invasive surgical interventions. However, future RCTs with larger sample sizes and extended follow-up periods are warranted to further validate the safety profile.