**4. Disadvantage of SIPES**

In comparison with CLS, increased postoperative pain and violation of ergonomic principles in SIPES were not proven in the published studies. Hernia might be a problem in adults published series, but we did not encounter any in our patients. In reverse SIPES, it is an opportunity to repair the umbilical hernia when closing the wound in pediatric age group. Wound infection was not different from conventional laparoscopy. Learning curve escalates fast, and the cost-effectiveness was proven to be less costly than conventional laparoscopy [3].
