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.

摘要

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.