Surgical Outcome in Bilateral Inguinal Hernia Repair: Laparoscopic Total Extraperitoneal Approach (TEP) as Best Approach?

Abstract

Introduction: Bilateral inguinal hernia is a distinct entity in the inguinal hernia category. Open and minimally invasive techniques for the treatment of bilateral inguinal hernia have been previously described. If resources and surgeon expertise are available, guidelines recommend laparoscopic repair for this entity. Methods:We analyzed data from 83 patients who underwent laparoscopic inguinal hernia repair (total extraperitoneal repair - TEP) of 158 hernias (146 inguinal hernias and 12 other types). Patients had bilateral symptomatic hernias. Results:Male predominance, with a mean age of 56.7 years, was noted. Lateral hernias (according to EHS classification) were prevalent (71.08%). In the majority of cases (77.11%), meshes made up of a custom polypropylene monofilament mesh were used, followed by Bard 3D Max mesh and Ultralight mesh. Regarding postoperative complications, seroma was the most frequently encountered one in our series (7.23%), followed by urinary retention and 'feeling' of mesh (2.41%). Hydrocele, wound hematoma, cord hematoma and chronic pain were seen in 1.20% of patients. No wound infections were observed. The average operative time was 97.77 minutes (SD=17.08); when associated surgery was present, it prolonged the operative time, and we found statistical significance (p=0.002). Similarly, the presence of recurrent hernia extended the operative time, which was found to be statistically significant (p=0.003). The conversion rate in our data was 2.41%. Drainage, which was performed in 13 patients (15.66%), decreased the incidence of complications, especially seroma (p=0.026). The mean length of hospital stay was 2.93 days (SD=1.81), with most of the patients having been discharged on the second postoperative day (37.35%). Only one recurrence was identified (1.20%). Conclusion:The laparoscopic approach for bilateral inguinal hernia treatment is feasible and has been proven to be advantageous. Our study emphasizes that the TEP procedure has low rates of complications, conversion and recurrence; hence, we recommend bilateral hernia repair.

FIGURE 1.

Plain dissection of the preperitoneal space with the telescope – detail; yellow arrow points to the Cooper’s ligament – ‘lighthouse’ in TEP approach (1)

FIGURE 2.

Placement of the two meshes overlapping in the middle (yellow arrows point to Cooper’s ligaments, green arrow points urinary bladder)

FIGURE 3.

Age distribution in patients with bilateral hernia repair

TABLE 1.

Age distribution in patients with bilateral hernia repair

TABLE 2.

Comorbidities in patients with bilateral hernia repair

FIGURE 4.

Comorbidities in patients with bilateral hernia repair

TABLE 3.

ASA score in patients with bilateral hernia repair

TABLE 4.

Association between length of hospital stay and different variables (significant association is considered when p<0.05)

TABLE 5.

Type of inguinal hernias based on location

FIGURE 5.

Type of bilateral hernias (orange for right inguinal hernia and blue for left inguinal hernia)

TABLE 6.

Associated surgery in patients with bilateral hernia repair

TABLE 7.

Association between operative time and different variables, with significant association being considered when p <0.05

TABLE 8.

Mesh type in patients with bilateral hernia repair

FIGURE 6.

Discharge day among patients with bilateral hernia repair

TABLE 9.

Overall complications in patients with bilateral hernia repair

FIGURE 7.

Complications in patients with bilateral hernia repair