Is prophylactic laparoscopic total extraperitoneal inguinal hernia repair on the contralateral side justified in less developed regions? A comparative study of bilateral to unilateral repair.

BACKGROUND

One of the benefits of total extraperitoneal repair (TEP) is that the contralateral side can be explored and repaired without the need for any further incisions. During a unilateral TEP repair, 11-50% of patients have been found to have a hernia on the contralateral side. The extraperitoneal laparoscopic repair on the contralateral side, done at a later date after the previous TEP, is quite difficult. We compared the morbidity parameters in bilateral to unilateral hernia repairs.

MATERIALS AND METHODS

A retrospective analysis was carried out over a 3-year period in 929 patients in whom TEP was done. The recurrence rate, pain scores at 24 hours and 1 week, hospital stay, seroma formation, and urinary retention rates were noted.

RESULTS

In 929 patients, 825 underwent bilateral and 104 unilateral hernia repair. Follow-up range was 12-40 months. The mean operating time was more in the bilateral group (31.3 +/- 5.5 minutes), compared to the primary group (23.7 +/- 5.5 minutes) (P = 0.0001). Mean pain scores at 24 hours and 1 week were similar in both groups. Hospital stay was also comparable in both groups (1.07 +/- 0.3 days for bilateral vs. 1.09 +/- 0.3 days for unilateral). Urinary retention rates and seroma formation were similar in both groups. Recurrence and conversion to open were also similar in both groups.

CONCLUSIONS

Compared to unilateral inguinal hernia repair, bilateral TEP repair is associated with a similar length of hospital stay, postoperative pain scores at 24 hours and 1 week, seroma formation, urinary retention rates, recurrence, and conversion rates. Therefore, the morbidity parameters in bilateral laparoscopic hernia repair are similar to unilateral repair.