Bilateral laparoscopic inguinal hernia repair in patients with occult contralateral inguinal defects.

Background: A high incidence of bilateral inguinal defects found on laparoscopic evaluation during hernia repair has been reported. However, expectation of bilateral inguinal defects in patients who are diagnosed with pure unilateral hernia might be underestimated. A prospective clinical study was performed to reveal a rate of contralateral occult defects in patients who were diagnosed with unilateral inguinal hernia prior to primary laparoscopic totally extraperitoneal (TEP) repair.

Methods: One hundred consecutive male patients with primary unilateral inguinal hernias were included in the study. Patients with known bilateral inguinal hernias as well as femoral, giant and combined hernias were excluded. All patients underwent TEP with exploration and evaluation of the contralateral groin.

Results: Median follow-up was 24 (4-46) months. Median age was 48 (18-73). Mean operative time was 42.2 (18-167) min. There were 78 (78%) patients with pure unilateral hernias and 22 (22%) patients with bilateral hernias whose contralateral inguinal defect or hernia was revealed only intraoperatively. Of those, 19 (86%) had right and 3 (14%) left occult defects. Minor complications occurred in 17 (17%) patients. There were no major complications. Two patients required a 23-hour stay in the hospital for urinary retention and hypoxia. Median period of returning to normal activity was 7 (5-14) days. There were two (2%) recurrences. Median period of returning to normal activity was 6.2 days after unilateral repair and 8.4 days after bilateral TEP.

Conclusion: This study revealed 22% occurrence of bilateral inguinal defects in the patients who are diagnosed with pure inguinal hernia before surgery, with higher incidence for those with left inguinal hernia. It appears that routine contralateral groin exploration and evaluation during TEP is valuable. Patients with occult bilateral hernias are benefit from bilateral TEP.