Occult contralateral inguinal hernias: what is their true incidence and should they be repaired?

Background: The true incidence of occult contralateral inguinal hernia is unknown; however, when found, there exists controversy as to whether or not they should be repaired. The aim of our study is to identify the incidence of contralateral incidental inguinal hernias in our surgical population, compare our results to previous studies timelining occult hernia identification to repair need, and generate debate as to whether incidental contralateral hernias should be repaired at the index operation.

Methods: We reviewed the charts of 297 consecutive patients undergoing robotic inguinal hernia repair between October 2014 and April 2018 at a single facility. By comparing preoperative physical examination to intraoperative findings, we determined the number of occult contralateral inguinal hernias in our patient population.

Results: Of 297 patients, 158 (53.2%) presented with a right inguinal hernia, 90 (30.3%) presented with a left inguinal hernia, and 49 (16.5%) presented with bilateral inguinal hernias. Forty-seven of the 297 patients (15.8%) were found to have an incidental contralateral inguinal hernia. Excluding patients with known bilateral inguinal hernias, 20% of patients with a left inguinal hernia were found to have an occult right inguinal hernia and 18.4% of patients with a right inguinal hernia were found to have an occult left inguinal hernia.

Conclusions: The true incidence of occult contralateral inguinal hernia may be higher than originally thought. When inguinal hernia repair is performed through a transabdominal approach, these occult hernias may be easily addressed during the same operation without additional skin incisions. This may ultimately prevent the morbidity of developing a metachronous hernia that requires repair.